Determinants of help seeking and treatment seeking behavior of Tuberculosis patients ‐ Gender perspective: A systematic review Gender differences in first-episode psychosis at 5-year follow-up--two different courses of disease? Results from the OPUS study at 5-year follow-up. Longitudinal Effects of Age at Onset and First Drinking Situations on Problem Drinking Histories of abuse predict stronger within-person covariation of ovarian steroids and mood symptoms in women with menstrually related mood disorder Gender differences in the subjective effects of MDMA Gender abuse, depressive symptoms, and HIV and other sexually transmitted infections among male-to-female transgender persons: a three-year prospective study. Predictors of drug-use patterns in maltreated children and matched controls followed up into middle adulthood. Defining and measuring health equity effects in research on task shifting interventions in high-income countries: a systematic review protocol The developmental antecedents of illicit drug use: evidence from a 25-year longitudinal study. Paths and impacts in the progressive independence model: a homelessness and substance abuse intervention in Chicago. Do different factors explain self-rated health in men and women? Where have they been? Service use of regular substance users with and without abuse and dependence Gender differences in violent behaviors: relationship to clinical symptoms and psychosocial factors. Gender Differences among Prisoners with Pre-Incarceration Heroin Dependence Participating in a Randomized Clinical Trial of Buprenorphine Treatment Study protocol for Women of Color and Asthma Control: A randomized controlled trial of an asthma-management intervention for African American women Introduction to 5-year followup treatment outcome studies. Gender and age influences on human brain mu-opioid receptor binding measured by PET. Factors influencing relapse in the long-term course of schizophrenia Is universal prevention against youths’ substance misuse really universal? Gender-specific effects in the EU-Dap school-based prevention trial A prospective investigation of physical health outcomes in abused and neglected children: new findings from a 30-year follow-up. What factors are associated with recent intimate partner violence? findings from the WHO multi-country study on women's health and domestic violence Reporting of Sex Effects by Systematic Reviews on Interventions for Depression, Diabetes, and Chronic Pain Four-year outcomes from adolescent alcohol and drug treatment.
Background Help and treatment seeking behavior of men and women suffering from tuberculosis is largely determined by how he/she and those around them perceive the causes , regard the diagnosis , accept the treatment , and adhere to the treatment . Objectives To critically appraise and synthesize the best available evidence on gender‐based determinants of help and treatment seeking behavior of tuberculosis patients . Inclusion criteria Male and female tuberculosis patients ( > = 15 years ) living in developed and developing countries were included . Quantitative studies examining gender differences in help and treatment seeking among tuberculosis patients with cross‐sectional , retrospective and prospect i ve cohort were included . Types of primary outcomes Outcomes related to determinants of help seeking : pattern of distress , perceived cause of tuberculosis and stigma related to tuberculosis patients and determinants of treatment seeking : delay in diagnosis , health service utilization , and consequence of treatment seeking ; treatment outcomes . Search strategy The review considered both published and unpublished studies in the English language published between January 1990 and December 2010 . Data bases of the Joanna Briggs Institute , PubMed , Popline , Cochrane Library , CINAHL and MedNar were search ed . The search focused on key elements of objectives ( participants , comparator , and outcome ) and a thorough search was undertaken utilizing a st and ardized three step approach . Method ological quality Considered papers were critically appraised by two independent review ers using st and ardized Joanna Briggs Institute tools . Data was extracted using the Joanna Briggs Institute Meta Analysis of Statistical Assessment and Review Instrument data extraction tool . Data was analyzed using Revman 5.1 software from the Cochrane collaboration . Results Nine cross‐sectional , two retrospective and one prospect i ve cohort studies were included in the review . Males were 49 % less likely to have psychological distress than females ( OR=0.51 , 95 % CI=0.32‐0.83 ) . Males were 46 % less likely to perceive health , illness and injuries as a cause of tuberculosis infection than females ( OR=0.54 , 95 % CI=0.31‐0.96 ) . Males were 78 % less likely to use a traditional healer as health service utilization than females ( OR=0.22 , 95 % CI=0.07‐0.66 ) . Males were almost twice more likely to be diagnosed within 30 days in a health institution than females ( OR=1.76 , 95 % CI=1.09‐2.84 ) however , they were 23 % less likely to successfully complete tuberculosis treatment ( OR=0.77 , 95 % CI=0.68‐0.87 ) . Conclusions Gender differences were observed on determinants of help seeking such as distress , perceived causes of tuberculosis infection and stigma components . Determinants of treatment seeking that showed significant gender differences were utilization of health services for diagnosis and treatment , patient delay in seeking health service and treatment outcome of tuberculosis . Implication s for Practice Gender specific strategies for behavioral change should be implemented by health professionals on causes of tuberculosis , early treatment seeking , signs/symptoms , related stigma and adherence of treatment to raise awareness in the community . Practitioners should suspect tuberculosis among women at early stages of their visits to health facilities and screen for tuberculosis . Special efforts should be made by practitioners for male tuberculosis patients to complete the treatment . Implication s for Research Further research with gender perspective should be conducted using behavioral change models on screening of patients and sensitizing communities to uptake of tuberculosis facilities for tuberculosis control OBJECTIVE Gender differences in psychosis have been investigated , and the results have contributed to a better underst and ing of the disease , but many questions are unanswered . In clinical terms , women and men with psychosis differ in terms of access to social support , tendency of substance abuse , level of functioning and symptom patterns . We aim ed to investigate how gender differences at onset of psychosis develop during the first 5years of treatment . METHOD A total of 578 patients with a first-episode psychosis in the schizophrenia spectrum were included in the Danish OPUS trial -- a r and omized clinical trial comparing 2 years of intensive early-intervention programme with st and ard treatment . All patients were assessed with vali date d instruments at inclusion , and after 2 and 5 years . Data were analysed for significant gender differences . RESULTS Males have significantly higher levels of negative symptoms at all times , and are more likely to live alone and suffer from substance abuse . Females reach higher levels of social functioning at follow-up , and show a greater tendency to be employed or in education than males . Markedly more women than men live with children . More women than men reach a state of recovery and are more compliant with medication . CONCLUSION There are significant gender differences at 2- and 5-year follow-up in this large cohort of first-episode psychotic patients . Males and females show different symptomatology and different levels of social functioning The purpose of this study was to describe aspects of the first alcohol-use experience , and examine the predictive relations among age of first use , context of alcohol use initiation , and problem drinking with and without controls for psychosocial risk factors . Data were from the Rutgers Health and Human Development Project , a five-wave , prospect i ve study of substance-use behaviors in a community sample . Respondents , who were first interviewed at age 12 ( 1979–81 ) and most recently at age 30 or 31 ( 1999–2000 ) ( N = 371 ) , reported on their first drinking experience , and on a range of known risk factors for alcohol abuse . Most alcohol initiation occurred during a family gathering . Regardless of initiation context , youth who drank at an early age were more likely than youth who initiated later to become problem drinkers , although the risk was relatively greater for the youth who first drank outside a family gathering . Based on multivariate logistic regressions , feeling drunk at initiation was the only onset-related variable significantly associated with problem drinking ; other significant risks factors included male gender , delinquency , and family history of alcoholism . Because most initiation occurs at a family gathering , alcoholism prevention research may benefit from examining the role that drinking in family context s could play with regard to socializing young drinkers to less risky drinking behaviors in adulthood . In particular , further research focusing on the subjective effects experienced by youth when they first drink may be merited OBJECTIVE Individual differences in sensitivity to cyclical changes in ovarian steroids estradiol ( E2 ) and progesterone ( P4 ) have been implicated in the pathophysiology of menstrually related mood disorder ( MRMD ) . However , no prospect i ve studies have investigated psychosocial risk factors for sensitivity to hormone effects on mood in MRMD . Using a repeated measures approach and multilevel models , we tested the hypothesis that a history of abuse provides a context in which within-person elevations of E2 and P4 prospect ively predict daily symptoms . METHOD 66 women with prospect ively-confirmed MRMD recruited for a trial of oral contraceptives provided  1 month of baseline hormone and mood data prior to r and omization . Lifetime physical and sexual abuse experiences were assessed . Across one cycle , women completed daily measures of symptoms and provided blood sample s on 5 days across the menstrual cycle . Current E2 and P4 were centered within person ( CWP ) such that higher values represented cyclical elevations in hormones . RESULTS Rates of physical ( 27 % ) and sexual ( 29 % ) abuse were high , consistent with previous work documenting a link between trauma and MRMD . In women with a history of physical abuse , cyclical increases in P4 predicted greater mood and interpersonal symptoms on the three days following that sample . In women with a history of sexual abuse , cyclical increases in E2 predicted greater anxiety symptoms on the three days following that sample . CONCLUSIONS Results inform further inquiry into the role of severe life stressors and stress response systems in MRMD . We discuss areas for future research on the psychosocial and physiological pathways through which abuse may influence the link between hormones and symptoms Abstract . Rationale : 3,4-Methylenedioxymethamphetamine ( MDMA ) mainly releases serotonin ( 5-HT ) and is contained in the recreational drug Ecstasy . 5-HT is known to play an important role in mood and anxiety disorders , for which there is a female preponderance . To date , there are no systematic data on gender differences in the subjective effects of MDMA . Objectives : The present work analyzed the pooled data from three controlled studies on the psychological and physiological effects of MDMA in healthy volunteers with no or minimal MDMA experience . A particular focus of the analyses were possible gender differences . Methods : A total of 74 subjects ( 54 male , 20 female ) participated in all three studies .  MDMA in oral doses ranging from 70–150 mg ( 1.35–1.8 mg/kg ) was administered under double-blind placebo-controlled conditions . Subjective peak changes were assessed by st and ardized psychometric rating scales . Physiological measures were blood pressure , heart rate , and peripheral body temperature . Adverse drug effects were assessed during the experimental session and after 24 h. Results : Psychoactive effects of MDMA were more intense in women than in men . Women especially had higher scores for  MDMA-induced perceptual changes , thought disturbances , and fear of loss of body control . The dose of MDMA positively correlated with the intensity of perceptual changes in women . Acute adverse effects and sequelae were also more frequent in female than in male subjects . In contrast , men showed higher increases in blood pressure than woman . Conclusions : The fact that equal doses of MDMA per kilogram body weight produce stronger responses in women compared to men is consistent with an increased susceptibility of women to the 5-HT-releasing effects of MDMA . Our results also indicate that increasing doses of MDMA produce more hallucinogen-like perceptual alterations , particularly in women OBJECTIVES We examined gender abuse and depressive symptoms as risk factors for HIV and other sexually transmitted infections ( HIV/STI ) among male-to-female transgender persons ( MTFs ) . METHODS We conducted a 3-year prospect i ve study of factors associated with incident HIV , syphilis , hepatitis B , chlamydia , and gonorrhea among 230 MTFs from the New York Metropolitan Area . Statistical techniques included Cox proportional hazards analysis with time varying covariates . RESULTS Among younger MTFs ( aged 19 - 30 years ) , gender abuse predicted depressive symptoms ( Center for Epidemiologic Studies Depression score ≥ 20 ) , and gender abuse combined with depressive symptoms predicted both high-risk sexual behavior ( unprotected receptive anal intercourse ) and incident HIV/STI . These associations were independent of socioeconomic status , ethnicity , sexual orientation , hormone therapy , and sexual reassignment surgery . CONCLUSIONS Gender abuse is a fundamental distal risk factor for HIV/STI among younger MTFs .  Interventions for younger MTFs are needed to reduce the psychological impact of gender abuse and limit the effects of this abuse on high-risk sexual behavior . Age differences in the impact of gender abuse on HIV/STI suggest the efficacy of peer-based interventions in which older MTFs teach their younger counterparts how to cope with this abuse OBJECTIVE This study examines whether  child abuse ; child neglect ; demographic , family and social , behavioral , economic , and neighborhood risk ; and protective factors predict different drug-use patterns into middle adulthood . METHOD Using a prospect i ve cohort design , individuals with documented cases of childhood physical and sexual abuse and neglect ( processed during 1967 - 1971 ) and a matched control group were followed into middle adulthood . Participants completed in-person interviews in 1989 - 1995 ( average age 29 ) , 2000 - 2002 ( average age 39.5 ) , and 2003 - 2004 ( average age 41 ) . The sample for this study included 374 women and 332 men . RESULTS Four patterns of drug use were revealed : ( a ) abstinence and low use ( 34 % ) , ( b ) adolescent and young adult limited use ( 31 % ) , ( c ) chronic-persistent use ( 29 % ) , and ( d ) late use ( 7 % ) . The chronic-persistent pattern was associated with being male , parental substance-use problems , involvement in crime , and neighborhood problems . The late-use pattern was significantly associated with childhood neglect and being Black , when other risk factors were controlled ; bivariate analyses also indicated associations with female gender , lower income , and greater neighborhood disadvantage . CONCLUSIONS This study revealed two patterns of drug use involving substance use and substance-related problems in middle adulthood that are associated with different sets of risk factors . Further research is needed to underst and the late-drug-use pattern , which appears to disproportionately involve low-income Black women with histories of childhood neglect . These individuals may be missed in efforts to prevent or reduce drug use among youths Introduction Task shifting interventions are intended to both deliver clinical ly effective treatments to reduce disease burden and address health inequities or population vulnerability . Little is known about how health equity and population vulnerability are defined and measured in research focused on task shifting . This systematic review will address the following questions : Among  task shifting interventions in high-income setting s that have been studied using r and omised controlled trials or variants , how are health inequity or population vulnerability identified and defined ? What methods and indicators are used to describe , characterise and measure the population ’s baseline status and the intervention ’s impacts on inequity and vulnerability ? Methods and analysis Studies were identified through data base search es ( MEDLINE , Embase , CINAHL , PsycINFO and Web of Science ) . Eligible studies will be r and omised controlled trials published since 2004 , conducted in high-income countries , concerning task shifting interventions to treat any disease , in any population that may face health disadvantage as defined by the PROGRESS-Plus framework ( place of residence , race/ethnicity/culture/ language , occupation , gender/sex , religion , social capital , socioeconomic position , age , disability , sexual orientation , other vulnerable groups ) . We will conduct independent and duplicate title and abstract screening , then identify related papers from the same programme of research through further data base and manual search ing . From each programme of research , we will extract study details , and definitions and measures of health equity or population vulnerability based on the PROGRESS-Plus framework . Two investigators will assess the quality of reporting and measurement related to health equity and vulnerability using a scale developed for this study . A narrative synthesis will highlight similarities and differences between the gathered studies and offer critical analyses and implication s. Ethics and dissemination This review does not involve primary data collection , does not constitute research on human subjects and is not subject to additional institutional ethics review or informed consent procedures . Dissemination will include open-access peer- review ed publication and academic conference presentations . PROSPERO Registration Number CRD42017049959 BACKGROUND The present study examined the developmental antecedents of illicit drug use and abuse/dependence . METHODS A 25-year prospect i ve longitudinal study of the health , development , and adjustment of a birth cohort of 1265 New Zeal and children . Measures included assessment s of adolescent and young adult illicit drug use and abuse/dependence ; cannabis use to age 25 ; measures of parental adjustment ; measures of exposure to childhood sexual abuse , physical abuse , and interparental violence ; novelty-seeking ; childhood and early adolescent adjustment and substance use ; and affiliation with substance-using peers . RESULTS Illicit drug use and abuse/dependence from ages 16 to 25 were significantly associated ( all p values<.05 ) with a range of parental adjustment measures ; exposure to abuse in childhood ; individual factors ; and measures of childhood and early adolescent adjustment . Analyses using repeated measures logistic regression models suggested that parental illicit drug use , gender , novelty-seeking , and childhood conduct disorder predicted later illicit drug use and abuse/dependence . Further analyses revealed that these pathways to illicit drug use and abuse/dependence were mediated via cannabis use , affiliation with substance-using peers , and alcohol use during ages 16 - 25 . CONCLUSIONS The current study suggested that the illicit drug use and abuse/dependence were associated with a range of early life circumstances and processes that put individuals at greater risk of illicit drug use and abuse/dependence . However , the use of cannabis in late adolescence and early adulthood emerged as the strongest risk factor for later involvement in other illicit drugs In an attempt to reduce homelessness and substance abuse , Chicago graduates of short-term inpatient substance abuse programs who lacked domiciles were placed into one of three conditions : ( 1 ) a case management only intervention ( n = 96 ) , ( 2 ) a case management with supported housing intervention ( n = 136 ) , or ( 3 ) a control condition ( n = 187 )  that allowed access to normal aftercare in the community . The two treatment interventions used a " progressive independence " approach , which focuses on simultaneously ameliorating tangible needs and clinical problems . Multivariate analyses suggest that subjects in both treatment interventions experienced lower levels of substance abuse and higher levels of residential stability than subjects in the control condition , as measured over the course of a year . Further analysis suggests that retention was improved by the focus on immediate tangible re sources , substance abuse was reduced by both the support of outpatient substance abuse treatment and the promulgation of changes in coping styles , and residential stability was increased by both the focus on access to income maintenance benefits and help with location of housing BACKGROUND Self-rated health has elicited special interest , in the wake of a number of studies demonstrating that it is a powerful predictor of future mortality , mare so for men than for women . The association between self-rated health and biological correlates also appears to differ between men and women , for reasons unknown . OBJECTIVE The purpose of this study was to examine gender differences in the interpretation and /or valuation of health-related information by comparing men and women 's association of abroad array of perceived health determinants with their statements about health . METHODS We conducted a cross-sectional study in a r and omly selected population of 8200 men and women aged > 17 years in Stockholm , Sweden . Subjects received a 120-item question naire that included measures of health care utilization , lifestyle , demographics , psychosocial factors , and mental , functional , and physical health . RESULTS Among the 5470 people who responded to the question naire , most of the 42 potential correlates ( 41 for men , 40 for women ) were significantly correlated to self-rated health . The overall association pattern was surprisingly similar for men and women . However , some small differences appeared : educational level , physical activity , and cultural activities played a more crucial role when men judged their health , whereas satisfaction with sleep and doctor visits played a more crucial role when women judged their health . These results were also for the most part confirmed in regression analyses that included all variables . The correlates explained 50 % of the variance in self-rated health for both men and women . CONCLUSIONS Our results highlight the necessity of taking a broad perspective on potential correlates when analyzing mechanisms of self-rated health . When judging their own health , men and women appear to consider approximately the same broad array of factors . The similarities in association patterns indicate that men and women interpret and /or value health-related factors similarly when making statements about health . These results may influence the medical profession 's acceptance or consideration of self-rated health . Underst and ing the gender-specific mechanisms involved in the assessment of self-rated health may contribute to the promotion of health-protective behavior and health intervention practice Objective To present lifetime rates of service use  for psychological and substance use related problems among regular substance users and to examine factors associated with service use . Method Data come from a prospect ive-longitudinal , epidemiological study of a community sample of adolescents and young adults ( n = 2548 , age 14–24 years at baseline ) in Munich , Germany . The Munich-Composite International Diagnostic Interview ( M-CIDI ) was used at baseline and at two follow-ups to assess substance use and service use . Results Cumulated lifetime incidence of any substance abuse or dependence was 43.7 % . Of those with abuse and dependence 23 % had ever used any services for psychological or substance use related problems . Illicit substance users especially those with dependence had the highest rates of lifetime service use ( 52.1 % ) . Psychotherapists and counseling services were contacted most frequently among regular substance users over their lifetimes . Utlilisation rates of substance abuse services were low ( 2 % ) . Comorbid anxiety disorders and distressing life events were associated with increased lifetime service use . Conclusions Only a minority of adolescents and young adults with substance use disorders have ever sought professional help . Specialized substance abuse services play only a minor role . The core role of psychotherapists and non-substance abuse specialized services needs critical research attention . Linkages between psychotherapists and the substance use service system should be strengthened to detect and intervene at early developmental stages of abuse and dependence OBJECTIVE Men are more violent than women in the general population , but this has not been found to be the case among psychiatric in patients . The reason for this exception is poorly understood . The present study investigated gender differences in violent behaviors among patients with major psychiatric disorders . It examined various clinical symptoms and psychosocial factors to determine their differential impact on violence in men and women . METHOD Physical assaults and verbal assaults committed by psychiatric in patients were recorded prospect ively . Patients whose violent incident occurred during their first 2 months of hospitalization were eligible for the study .  Patient history of community violence was also obtained .  Psychiatric symptoms  and  ward behaviors  were assessed upon entry into the study and after 4 weeks . RESULTS A similar percentage of women and men had an incident of physical assault in the hospital . Among the patients entered into the study , the women had a much higher level of verbal assaults throughout the evaluation period and a higher level of early physical assaults ( i.e. , within the first 10 days of the 4-week study period ) . Positive psychotic symptoms were more likely to result in assaults in women than in men . Physical assaults in the community , on the other h and , were more common in men and were associated with substance abuse , property crime , and a history of school truancy . CONCLUSIONS There are gender differences in the patterns of violent behavior among patients with major psychiatric disorders . Furthermore , psychiatric symptoms and psychosocial risk factors have a different impact on this behavior in men and women . This has important implication s for the prediction and differential treatment of violent behavior The primary focus of the current study is to examine whether gender and other baseline characteristics were significantly associated with more severe patterns of drug use . It involves data from 260 male and female prerelease prison inmates with preincarceration heroin dependence who enrolled in a r and omized clinical trial of prison-initiated buprenorphine .  Three outcomes are examined : ( a ) lifetime intravenous drug use , ( b ) lifetime number of drugs used , and ( c ) heroin use in prison . Regarding lifetime intravenous drug use ; race ( p < .001 ) , education ( p < .009 ) , age ( p < .001 ) , and psychological treatment ( p = .028 ) were significant . Concerning lifetime number of drugs used ; race ( p < .001 ) and age of first crime ( p = .001 ) were significant . Finally , gender ( p = .004 ) , was the only significant variable in terms of using heroin while in prison . All of these differences may have important clinical , treatment , and research implication s , which are discussed Background Among adults in the United States , asthma prevalence is disproportionately high among African American women ; this group also experiences the highest levels of asthma-linked mortality and asthma-related health care utilization . Factors linked to biological sex ( e.g. , hormonal fluctuations ) , gender roles ( e.g. , exposure to certain triggers ) and race ( e.g. , inadequate access to care ) all contribute to the excess asthma burden in this group , and also shape the context within which African American women manage their condition . No prior interventions for improving asthma self-management have specifically targeted this vulnerable group of asthma patients . The current study aims to evaluate the efficacy of a culturally- and gender-relevant asthma-management intervention among African American women . Methods / Design A r and omized controlled trial will be used to compare a five-session asthma-management intervention with usual care . This intervention is delivered over the telephone by a trained health educator . Intervention content is informed by the principles of self-regulation for disease management , and all program activities and material s are design ed to be responsive to the specific needs of African American women . We will recruit 420 female participants who self-identify as African American , and who have seen a clinician for persistent asthma in the last year . Half of these will receive the intervention . The primary outcomes , upon which the target sample size is based , are number of asthma-related emergency department visits and overnight hospitalizations in the last 12 months . We will also assess the effect of the intervention on asthma symptoms and asthma-related quality of life . Data will be collected via telephone survey and medical record review at baseline , and 12 and 24 months from baseline . Discussion We seek to decrease asthma-related health care utilization and improve asthma-related quality of life in African American women with asthma , by offering them a culturally- and gender-relevant program to enhance asthma management . The results of this study will provide important information about the feasibility and value of this program in helping to address persistent racial and gender disparities in asthma outcomes .Trial Registration Clinical Trials.gov : National evaluations of  drug treatment  outcomes and processes over the past 30 years have been an important source of ‘ ‘ real-world ’ ’ evidence for the effectiveness of treatment in the U.S. While they are more limited than experimental protocol s in their capacity to establish scientific causality , they excel in documenting naturally occurring patterns of treatment delivery and patient recovery . The Drug Abuse Treatment Outcome Studies ( DATOS ) is the third national evaluation of community-based treatment effectiveness funded by the National Institute on Drug Abuse ( Flynn , Craddock , Hubbard , And erson , & Etheridge , 1997 ) following the Drug Abuse Reporting Program from the 1970s ( see Simpson & Sells , 1982 , 1990 ) and the Treatment Outcomes Prospect i ve Study from the 1980s ( see Hubbard , Marsden , Rachal , Harwood , Cavanaugh , & Ginzburg , 1989 ) . The National Treatment Outcome Research Study ( NTORS ) has followed the same general model to provide the first large-scale evaluation of its kind in the United Kingdom ( Gossop , Marsden , Stewart , & Kidd , 2003 ) . Sets of papers focused on 1-year outcomes and treatment process from DATOS and NTORS have been published in special issues of Psychology of Addictive Behaviors ( Simpson & Curry , 1997 ) and Drug and Alcohol Dependence ( Simpson & Brown , 1999 ) , and evaluations of treatment for adolescents in DATOS were reported in a special issue of the Journal of Adolescent Research ( Grella & Hser , 2001 ) . Overviews of 1-year and 5-year treatment outcomes for adult cocaine users were also reported in Archives of General Psychiatry ( Simpson , Joe , Fletcher , Hubbard , & Anglin , 1999 ; Simpson , Joe , & Broome , 2002 ) , along with 1-year treatment outcomes for adolescents ( Hser et al. , 2001 ) . Bullet reports and charts that summarize findings of 75 publications from DATOS are available on its website at www.datos.org . Outcome evaluations reported in this issue and previously were conducted by the four collaborating research OBJECTIVE Both age and gender are being increasingly recognized as important factors influencing CNS structure and function . However , there are relatively few data on actual neurochemical differences between the sexes in human subjects or on their interaction with age . One of the central neurotransmitter systems for which sex differences have been suggested by animal models and clinical human data is the opioid . In this study the authors examined age- and gender-associated variations in mu-opioid receptor binding with positron emission tomography ( PET ) . METHOD Healthy human subjects were studied with PET and the radiotracer [11C]carfentanil , a selective mu-opioid agonist .  Two separate subject groups were examined : one group of 24 men and 12 women was studied in a retrospective analysis of data , and a second group of 12 men and 18 women was recruited prospect ively and studied with a higher-resolution scanner .  RESULTS Mu-opioid receptor binding potential ( Bmax/Kd ) was found to increase with age in neocortical areas and the putamen . Sex differences , with higher mu-opioid binding in women , were observed in a number of cortical and subcortical areas . Gender-by-age interactions were observed in the thalamus and the amygdala ; in vivo mu-opioid binding declined in postmenopausal women to levels below those of men . CONCLUSIONS These data imply that both age and gender are important variables to consider in the interpretation of investigations of human function in which the opioid system plays a role . Also , women 's reproductive status ( reproductive age versus postmenopausal ) may influence the function of CNS opioid systems Highly effective neuroleptic drugs have been available for the past 40 years , but 50 % of schizophrenic patients , under normal treatment conditions , relapse within 1 year after their latest episode , frequently spending 15 - 20 % of their time in psychiatric institutions . The term relapse usually refers to a deterioration or recurrence of positive rather than negative features , and relapses appear to impair the course of the disease . Impairment is often longer than expected for those patients who discontinue antipsychotic medication and then relapse to their prediscontinuation clinical state of function . Drug therapy is an important defense against relapse . Marked differences in relapse rate between patients receiving placebo and neuroleptic drugs  have been observed ( approximately 69 % after 1 year for the placebo group versus 26 % for the neuroleptic group ) . First-year relapse rates can be reduced from 75 % to 15 % with prophylactic treatment with neuroleptics . Follow-up studies suggest that noncompliance with medication , pharmacological factors , psychosocial factors and alcohol and drug abuse contribute to setting off new psychotic episodes . The most important of these is noncompliance with medication . The overwhelming majority of schizophrenic patients who suffered a clinical exacerbation and required hospitalization ( 73 % ) did not comply with the treatment prescribed . The effect of new antipsychotic agents should be examined in patients who relapse despite maintenance treatment with conventional neuroleptics . We have found that the rate of current drug abuse among patients with schizophrenic relapse ( 44 % ) was significantly higher than that in schizophrenic patients who regularly attended outpatient clinics . Also , the rate of alcohol and substance abuse is higher in males ( 79 % ) than in females ( 21 % ) . Psychiatric units should integrate addiction treatments with psychotic-relapse management Background : Studies of effectiveness of school-based prevention of substance misuse have generally overlooked gender differences . The purpose of this work was to analyse gender differences in the effectiveness of a new European school-based curriculum for prevention of substance misuse among adolescents . Methods : The European Drug Abuse Prevention ( EU-Dap ) trial took place in seven European countries during the school year 2004–05 . Schools were r and omly assigned to either a control group or a 12-session st and ardised curriculum ( “ Unplugged ” ) based on a comprehensive social influence model . The analytical sample consisted of 6359 students ( 3324 boys and 3035 girls ) . The use of cigarettes , alcohol and illicit drugs , adolescents ’ knowledge and opinions about substances , as well as social and personal skills were investigated through a self-completed anonymous question naire administered at enrolment and 3 months after the end of the programme . Adjusted Prevalence Odds Ratios were calculated as the measure of association between the intervention and behavioural outcomes using multilevel regression modelling . Results : At enrolment , boys were more likely than girls to have used cannabis and illicit drugs , whereas girls had a higher prevalence of cigarette smoking . At the follow-up survey , a significant association between the programme and a lower prevalence of all behavioural outcomes was found among boys , but not among girls . Age and self-esteem emerged as possible modifiers of these gender differences , but effects were not statistically significant . Conclusions : Comprehensive social influence school curricula against substance misuse in adolescence may perform differently among girls and boys , owing to developmental and personality factors OBJECTIVES We investigated whether abused and neglected children are at risk for negative physical health outcomes in adulthood . METHODS Using a prospect i ve cohort design , we matched children ( aged 0 - 11 years ) with documented cases of physical and sexual abuse and neglect from a US Midwestern county during 1967 through 1971 with nonmaltreated children . Both groups completed a medical status examination ( measured health outcomes and blood tests ) and interview during 2003 through 2005 ( mean age=41.2 years ) . RESULTS After adjusting for age , gender , and race , child maltreatment predicted above normal hemoglobin , lower albumin levels , poor peak airflow , and vision problems in adulthood . Physical abuse predicted malnutrition , albumin , blood urea nitrogen , and hemoglobin A1C . Neglect predicted hemoglobin A1C , albumin , poor peak airflow , and oral health and vision problems , Sexual abuse predicted hepatitis C and oral health problems . Additional controls for childhood socioeconomic status , adult socioeconomic status , unhealthy behaviors , smoking , and mental health problems play varying roles in attenuating or intensifying these relationships . CONCLUSIONS Child abuse and neglect affect long-term health status-increasing risk for diabetes , lung disease , malnutrition , and vision problems- and support the need for early health care prevention Background  Intimate partner violence ( IPV ) against women is a global public health and human rights concern . Despite a growing body of research into risk factors for IPV , method ological differences limit the extent to which comparisons can be made between studies . We used data from ten countries included in the WHO Multi-country Study on Women 's Health and Domestic Violence to identify factors that are consistently associated with abuse across sites , in order to inform the design of IPV prevention programs . Methods St and ardised population -based household surveys were done between 2000 and 2003 . One woman aged 15 - 49 years was r and omly selected from each sample d household . Those who had ever had a male partner were asked about their experiences of physically and sexually violent acts . We performed multivariate logistic regression to identify predictors of physical and /or sexual partner violence within the past 12 months . Results Despite wide variations in the prevalence of IPV , many factors affected IPV risk similarly across sites . Secondary education , high SES , and formal marriage offered protection , while alcohol abuse , cohabitation , young age , attitudes supportive of wife beating , having outside sexual partners , experiencing childhood abuse , growing up with domestic violence , and experiencing or perpetrating other forms of violence in adulthood , increased the risk of IPV . The strength of the association was greatest when both the woman and her partner had the risk factor . Conclusions IPV prevention programs should increase focus on transforming gender norms and attitudes , addressing childhood abuse , and reducing harmful drinking . Development initiatives to improve access to education for girls and boys may also have an important role in violence prevention Differences in disease prevalence , clinical manifestations , and health outcomes exist between men and women . Sources for this variation range from biological differentiation at the cellular level to behavioral differences influenced by societal gender norms . Typically , biologically based differences between men and women are called sex differences , whereas gender differences describe health differences related , at least in part , to societal constructs of gender ( 13 ) . For example , biological events unique to women , such as pregnancy and menopause , are probably associated with sex differences in occurrence of certain conditions or in response to some medical therapies ( 48 ) . Gender differences probably exist in health-related perceptions and behaviors for women and men with medical conditions that are prevalent for both sexes ( for example , heart disease and chronic pain ) ( 9 –16 ) . Although sex and gender differences are theoretically distinct , they remain difficult to disentangle when differences between men and women in health outcomes and treatment effectiveness are being examined . For this reason , and for brevity , we hereafter refer to sex and gender differences collectively as sex effects . In the past 2 decades , recognition of the importance of sex effects for health outcomes and treatment heterogeneity has been growing . Beginning in 1993 , the National Institutes of Health has issued policies requiring the inclusion of women and minorities in all clinical research and trial design s with valid analysis of sex effects or differences between racial and ethnic groups ( 17 , 18 ) . Since then , the inclusion of women in clinical trials has increased ( 19 , 20 ) , and sex effects have been identified for medications , such as nicotine replacement therapy , analgesics , and aspirin ( 13 , 14 , 21 ) . Recently , sex effects in adverse reactions led to sex-specific dosage recommendations for a widely used sedative ( 7 ) . Despite this progress , representation of women in clinical studies remains inadequate for many conditions ( 22 ) . Further , published clinical trials infrequently report sex effects or discuss the appropriateness of sex-specific analyses ( 19 , 20 , 23 ) . To advance the clinical evidence base and improve health outcomes for women , clinical research must include adequate numbers of women , appropriately conduct sex-specific analyses , and consistently report sex effects . Systematic review s ( SRs ) are a key source of information for clinicians , research ers , and guideline panels . By synthesizing the overall body of evidence for key clinical and research questions , SRs could potentially make a unique contribution to the evaluation of sex effects . To our knowledge , however , the reporting of sex effects by SRs has not been previously examined . Here , we use evidence mapping to systematic ally evaluate the reporting of sex effects by SRs examining a diverse set of interventions for chronic conditions common to women ( that is , depression , diabetes , and chronic pain ) . Evidence mapping is an emerging approach that describes key characteristics of studies for a broad area of medicine ( 2426 ) . Our evidence map addresses the volume and characteristics of eligible SRs , including the representation of women in primary studies , whether and how review s reported sex effects , and findings about sex effects . Methods This work was part of a larger report for the Veterans Health Administration ( VHA ) Evidence -based Synthesis Program ( ESP ) . The complete technical report is available online ( www.hsrd . research .va.gov/publications/esp ) and includes additional information on our methods . We focused on SRs to determine the reporting of sex effects , provide high-level information about the volume of current clinical evidence , and summarize information about actual sex effects . Prioritization of Conditions for Inclusion We used forced-ranking prioritization ( 27 ) with our VHA stakeholders to determine our conditions of interest . These stakeholders included representatives from the Health Services Research & Development Center for the Study of Healthcare Innovation , Implementation and Policy ; Health Services Research & Development Women 's Health Research Network ; Women 's Health Research in the Office of Research & Development ; Women 's Health Services ; and Mental Health Services . We initially selected 34 conditions ( Appendix Table 1 ) based on disease prevalence in women , disease burden in women , availability and breadth of effective treatments for men or women , and women veterans ' priorities for gender-specific care . Stakeholders ranked this initial set of conditions , discussed the rankings , and reranked conditions that initially received intermediate priority rankings . After 2 rounds of iterative prioritization , the following conditions were selected : depressive disorders , type 2 diabetes mellitus , and chronic pain ( that is , chronic low back pain , fibromyalgia , and chronic knee pain due to osteoarthritis ) . Appendix Table 1 . Conditions Presented to Stakeholders for Prioritization * Data Sources and Search es In collaboration with an expert reference librarian , we search ed PubMed and Cochrane Data base of Systematic Review s to identify eligible SRs published after 1 October 2009 through 31 October 2014 for depression , 13 February 2015 for diabetes , and 27 February 2015 for chronic pain . Search strategies used Medical Subject Headings and free-text terms for the conditions of interest , eligible interventions , and SRs ( Appendix Table 2 ) . We restricted the search to the past 6 years because SRs are typically out date d within 5 years of publication ( 28 ) , and our goal was to describe the current state of the clinical literature . In addition to electronic search ing , we screened published review s of review s for eligible articles . Appendix Table 2 . Search Strategies Study Selection and Quality Assessment Eligible SRs evaluated interventions in several broad categories ( that is , medications , behavioral interventions , supervised exercise , and quality improvement or organizational interventions ) . We also included condition-specific interventions , such as bariatric surgery for diabetes . Review s that evaluated mixed conditions or multiple interventions must have reported results separately for at least 1 eligible condition or intervention . We included review s of interventions in any setting , with any type of active or inactive comparator , and with any duration of follow-up . Detailed inclusion and exclusion criteria are provided in Appendix Table 3 . Appendix Table 3 . Detailed Inclusion and Exclusion Criteria for Review Eligibility Two investigators screened citations for eligibility , and citations that were considered to be relevant by either person were retained for full-text review . Full-text articles were review ed by 2 investigators , and disagreements were resolved through discussion or adjudicated by a third person . Formal assessment of review quality was beyond the scope of this project . However , we noted whether review s originated from organizations known for high- quality review s ( that is , Cochrane Collaboration , Agency for Healthcare Research and Quality Evidence -based Practice Centers , and VHA ESP ) . For review s reporting sex effects , we also assessed industry funding and whether statistical power was considered . Data Abstract ion Data were abstract ed by 1 investigator and review ed by a second person . Disagreements were resolved by discussion or by a third review er . Abstract ed data included the analysis method ( that is , qualitative synthesis , meta- analysis , network meta- analysis , or individual-patient data [ IPD ] meta- analysis ) ; clinical conditions ; interventions ; main outcomes ; number and design of primary studies ( for example , r and omized , controlled trials [ RCTs ] or observational cohorts ) ; proportion of women in the included primary studies ; and if sex effects were part of the study aims , analysis plan , or results . For review s reporting sex effects , we also recorded the number of primary studies used for sex-specific analyses , effect estimates , and the method used ( for example , metaregression , subgroup analysis , or IPD meta- analysis ) . All eligible review s on depressive disorders and chronic pain conditions were fully abstract ed . All diabetes review s of nonpharmacologic interventions were also fully abstract ed . For eligible diabetes medication review s ( n= 120 ) , we applied an additional prioritization procedure before full abstract ion . We prioritized review s that examined multiple classes of medications or evaluated a single class of medications when 6 or fewer eligible review s were identified . For SRs evaluating a single class ( > 6 eligible review s were identified ) , we used additional prioritization criteria ( for example , the most recent review published in a high-impact journal or work done by an organization known for high- quality review s ) . The remaining unselected but eligible review s ( n= 58 ) had a keyword text search for sex effects and were fully abstract ed only when this search yielded positive results ( n= 13 ) . Data Synthesis and Analysis of SRs We grouped eligible review s by intervention category and described the overall volume of clinical literature for interventions addressing each condition of interest . We also determined the number of review s reporting sex effects and summarized these results . Time trends for the proportion of these review s were examined for depression and diabetes . Examination of Primary RCTs for Selected Interventions We anticipated that some interventions for each condition would have few or no eligible SRs that addressed sex effects . Thus , for a subset of interventions for each condition , we evaluated primary RCTs to determine the feasibility of conducting a future review to evaluate sex effects . Specifically , we examined  quality improvement interventions and psychotherapy for depression ; diet , physical activity , and culturally tailored psychoeducation for diabetes ; behavioral interventions for chronic low back pain ; and exercise interventions OBJECTIVE Knowledge of treatment response for alcohol and drug problems among adults is mounting ; less is known about long-term outcome for adolescents who receive treatment for alcohol and drug problems .  The current study examined youth substance involvement over 4 years ( using five waves of data collection ) following treatment for alcohol and drug abuse . METHOD A cohort of youth ( N = 162 , 60 % male ) treated during adolescence ( mean age = 16 years ) was followed into young adulthood , a period associated with stabilization of alcohol use patterns and elevated risk for life problems secondary to both alcohol and drug use . Participants ( 14 - 18 years old ) were consecutive admissions to inpatient adolescent alcohol and drug treatment centers in San Diego that were abstinence focused and based on the 12-step approach . RESULTS Alcohol and other drug use were reduced during the 4 years posttreatment , with the exception of nicotine . The greatest prevalence reduction occurred for stimulants ; modest changes were evident in alcohol and marijuana use . Nicotine was the most commonly used substance throughout the 4 years after treatment . Several distinct substance involvement trajectories were evident during the 4 years following treatment . CONCLUSIONS Alcohol and drug use patterns during the 4 years following treatment highlight both changes and diversity in substance involvement as youth make the transitions from middle to late adolescence and into young adulthood . Findings demonstrate the importance of identifying transitional periods and the need for alternative intervention strategies that may help the progression of this population into young adulthood
Such prevalence rates have not been observed in adolescents .
Differences between men and women involve : ( i ) the biological response to the drug , ( ii ) the progression to drug dependence , and ( iii ) the comorbid psychiatric diagnoses , which may be due to both sociocultural factors and innate biological differences .
The introduction of gender into forensic toxicological evaluations may help eluci date the relationship between the body 's absorption of abused drugs ( alone or in combination ) and the onset of intoxications , both lethal and none
Gender differences in substance use/abuse have been the focus of research in the last 15 years .
Initiation , use patterns , acceleration of disease course , and help-seeking patterns are known to be influenced by gender differences with regard to biological , psychological , cultural and socioeconomic factors .
This paper presents a systematic review of published data on gender differences in the use/abuse of psychoactive and psychotic drugs , focusing on the importance of a multidisciplinary approach .
A crucial role played by ovarian hormones ( oestrogens and progesterone ) has been documented in both human and animal model studies .