Do Canadian female surgeons feel discriminated against as women?

OBJECTIVE: To describe female surgeons'' perceptions of discrimination against them as women during the selection and training process and in career development and advancement, and to describe trends over time. DESIGN: Population survey of practising Canadian female surgeons. SETTING: Canada. PARTICIPANTS: All 459 female members in good standing of the Royal College of Physicians and Surgeons of Canada or the Corporation professionnelle des médecins du Québec, or both, practising in Canada as of March 1990. Participants completed a survey between March 1990 and May 1992, the response rate was 91% (419/459). OUTCOME MEASURES: Reported levels of discrimination during selection and training and in career development and advancement, institutional policies on maternity leave and job sharing, and the existence of female role models or mentors. RESULTS: Discrimination during the process of selection for residency was reported by 15% (63/413) of the respondents. Just over half of the respondents (206/405) reported male attending staff as being discriminatory during training, and 41% (168/407) reported nursing staff as being discriminatory. Almost half of the respondents (199/408) indicated that discrimination did not hinder their career development or advancement at all, and 29% (118) indicated that it had little effect. Almost two thirds (245/381) reported no maternity leave policies during residency or practice, and 78% (296/379) reported having no job-sharing opportunities. Although 82% (338/413) agreed that female medical students need female role models, 80% (330/415) reported they did not have a female mentor. CONCLUSIONS: Although most of our respondents perceived no discrimination in their selection for residency and reported that discrimination did not hinder their career development or advancement, the perception of discrimination during surgical training suggests that there needs to be a concentrated effort to identify and address problems. Moreover, since few respondents reported having institutional policies on maternity leave and job-sharing or female mentors, these issues need to be examined.     

Coronary artery disease: Are men and women created equal?

Background: Ischemic heart disease in women is a difficult issue in cardiovascular medicine, mainly because of our lack of understanding of the early-stage mechanisms and symptoms. A better and earlier understanding of the pathophysiology of coronary artery disease (CAD) in women will enable us to detect ischemic heart disease earlier and prevent adverse clinical outcomes.Objectives: The aims of this article were to describe the phenomenon of ischemic heart disease in women, increase awareness of the difference between men and women in relation to ischemic heart disease, improve our understanding of the mechanisms that cause this difference, and identify new approaches for better and earlier detection and treatment of CAD in women.Methods: We conducted a search of the PubMed database for double-blind studies on the mechanistic pathways of CAD in women published in English within the past 10 years and epidemiologic studies published since 1970. Search terms included women and coronary artery disease and ischemic heart disease in women.Results: The literature search revealed 30 peer-reviewed articles pertaining to this issue. The incidence of CAD was markedly lower in women <60 years of age than in older women. After 60 years of age, the rate of CAD increased and reached the rate seen among men by the 8th decade of life. The gender difference in atherosclerosis in the coronary tree was particularly large in patients <55 years of age and remained large at older ages. The gender difference in the coronary bed was strikingly larger than in other vascular beds. Intensive risk-factor modification had a similar effect on plaque progression in both men and women. Coronary endothelial dysfunction appeared to be related to cardiovascular morbidity and mortality in women as well as in men, and because endothelial dysfunction could be modified, it appeared that the prognosis could be improved by appropriate management. A strong association was found between body mass index (BMI) and metabolic status, but only the metabolic syndrome was associated with CAD. Physical activity was independently associated with fewer risk factors, less CAD, and fewer adverse events in women; however, obesity was not associated with these outcomes.Conclusions: Results of the identified studies suggest that reduction of risk factors is a common approach to fighting heart disease in both sexes. It appears that for women, weight and BMI are not as important as previously thought, but physical exercise and fitness are very important and can change risk factors and clinical outcomes more than any other known intervention. Data suggest that global inflammation may play an important role in women and may predict cardiovascular outcome in women much better than the traditional risk factors that have been used and proved for men.     

Coronary artery bypass grafting: how much does it cost?

OBJECTIVE: To calculate the cost of coronary artery bypass grafting (CABG) and to compare it with the costs determined in two previous Canadian studies. DESIGN: Retrospective cost-analysis study. SETTING: A tertiary care referral hospital. PATIENTS: Fifty patients who had undergone successful triple and quadruple CABG between Jan. 3 and 30, 1989. MAIN RESULTS: The cost of CABG per patient varied from $10,982 to $33,676 (mean $14,328) (in 1988 Canadian dollars). The cost tended to increase with age and number of vessels grafted. Compared with the patients in the two previous Canadian studies our patients were older, had more vessels grafted and cost more to treat, even after the total hospital costs were adjusted for inflation. CONCLUSIONS: The population undergoing CABG is changing: it is older and has more diseased vessels. These changes have had a significant impact on the cost of CABG. Further study is required to determine the outcome and benefit of CABG in this group of patients.     

Coronary three-vessel disease with occlusion of the right coronary artery: What are the most important factors that determine the right territory perfusion?

With progressive occlusion of a coronary main artery, some anastomotic vessels are recruited in order to supply blood to the ischemic region. This collateral circulation is an important factor in the preservation of the myocardium until reperfusion of the area at risk. An accurate estimation of collateral flow is crucial in surgical bypass planning as it alters the blood flow distribution in the coronary network and can influence the outcome of a given treatment for a given patient. The evaluation of collateral flow is frequently achieved using an index based on pressure measurements. It is named collateral flow index (CFI) and defined as: (P_w − P_v)/(P_ao − P_v), where P_w is the pressure distal to the thrombosis, P_ao the aortic pressure and P_v the central venous pressure. In the present work, we study patients with severe coronary disease (stenoses on the left branches and total occlusion of the right coronary artery). Using a mathematical model that describes the coronary hemodynamics in that situation, we demonstrate that the dependence of the collateral circulation to the pressure values is not as simple as it is commonly believed: using pressures alone as an index of collateral flow is likely to result in misinterpretation of the collateral flow contribution, because collateral flow depends on many other factors related to the status of the native stenosed arteries and to the microvascular resistances (capillary and collateral resistances, and the proportion between them).     

Why are women predisposed to autoimmune rheumatic diseases?

The majority of autoimmune diseases predominate in females. In searching for an explanation for this female excess, most attention has focused on hormonal changes - both exogenous changes (for example, oral contraceptive pill) and fluctuations in endogenous hormone levels particularly related to menstruation and pregnancy history. Other reasons include genetic differences, both direct (influence of genes on sex chromosomes) and indirect (such as microchimerism), as well as gender differences in lifestyle factors. These will all be reviewed, focusing on the major autoimmune connective tissue disorders: rheumatoid arthritis, systemic lupus erythematosus and scleroderma.     

Coronary artery bypass grafting in Canada: What is its rate of use? Which rate is right?

We reviewed recent reports from administrative databases and clinical registries addressing the utilization of coronary artery bypass grafting (CABG) in Canada. The Canadian CABG rate per 100,000 people increased from 31.1 to 43.2 between 1981-82 and 1986-87. Between 1981 and 1986 the rate in the United States increased from 69.9 to 95.3 per 100,000, consistently about two times the Canadian rate. Provincial data have shown particular growth in utilization among elderly people. However, in the United States the 1985 CABG rate was twice as high as the aggregated age-specific rates for Ontario and Manitoba among people 65 to 74 years of age and four times higher among those 75 years or more. Limited registry data suggest that the Canadian CABG case mix is similar to the case mix in major US centres and that, utilization growth notwithstanding, the procedure is largely applied to patients who should, in theory, benefit (i.e., those with severe angina, impaired left ventricular function and left main-stem or triple-vessel disease). However, chart audits and registry evaluations using explicit criteria are needed to compare the use of CABG in Canada and the United States. In addition, Canadian data show moderate regional and municipal variations, the 1986-87 rates per 100,000 population in major census metropolitan areas varying from 19.5 to 46.9. Areas with consistently low rates raise particular concerns about impaired access to CABG. Reasons for variations should therefore be a research priority.     

Student report--the fight against cancer and angiogenesis inhibitors: are we entering a new era?

Chemoresistance is currently the main cause of failure in the treatment of cancer which, despite extensive research, remains unsolved. In this report the theoretical assumptions underlying antiangiogenic therapy are described and future perspectives and limits are discussed.     

Human nakedness: adaptation against ectoparasites?

Homo sapiens L. has been described as the naked ape, and this nakedness undoubtedly constitutes one of the most striking differences in appearance between man and the apes. Nakedness has been attributed at various times to sexual selection [1], aquatic stage [2], hunting [3], cooling [4], sex [5], neoteny [6] and allometry [7], most proposed explanations logically revealing some aspect of the phenomenon. However, most fail to account for the distinctiveness of man's hairlessness among mammals of the same size. Unfortunately, fossils cannot help us to explain how denudation occurred, and how it helped hominids to survive. In this paper I will present an old hypothesis with a new point of view incorporating more recent evidence.     

Worm therapy: for or against?

This article succinctly reviews the weight of evidence supporting worm therapy, and asks the question whether the evidence is sufficient to support the use of parasitic worms as investigational medicinal products.     

Gamma-aminobutyrate: defense against invertebrate pests?

Gamma-aminobutyrate (GABA) is a ubiquitous four-carbon, non-protein amino acid. In plants, stress-induced GABA accumulation is well documented. However, the role(s) of GABA accumulation is contentious. In this Opinion article, we argue that wounding due to herbivory and crawling by insect larvae causes rapid GABA accumulation via the disruption of cellular compartmentation and the release of the acidic vacuolar contents to the cytosol. The activity of glutamate decarboxylase, the cytosolic enzyme responsible for GABA synthesis, has an acidic pH optimum. Subsequent GABA ingestion has a plant defense function by directly acting on GABA-regulated invertebrate neuromuscular junctions. Plants with an enhanced GABA-producing capacity reduce herbivory by invertebrate pests. These findings suggest that GABA accumulation is a rapidly deployed, local resistance mechanism that constitutes a first line of defense in deterring herbivory.     

Anaesthesia and post-operative analgesia following experimental surgery in laboratory rodents: are we making progress?

Current attitudes to the use of animals in biomedical research require that any pain or distress should be minimised. This can often be achieved by the use of appropriate anaesthetic and analgesic regimens. There, is however, little information on the peri-operative regimens used. A literature review was conducted to estimate how commonly analgesics are administered to laboratory rodents, the most widely used species of laboratory animals, and to assess the anaesthetic regimens employed. Studies describing potentially painful experimental procedures involving rodents were identified from peer-reviewed journals published from 1990 to 1992 and from 2000 to 2002. In papers published between 2000 and 2002, if analgesic administration was not specified, the institutional veterinary surgeons or authors of the papers were contacted by e-mail to obtain additional information on analgesic use. From 1992 to 2002, there was an increase in the reported prevalence of analgesic administration to laboratory rodents from 2.7% to 19.8%. Although the use of analgesics has increased over the past ten years, the overall level of post-operative pain relief for laboratory rodents is still low. Anaesthetic methodology changed markedly between the two time-periods sampled. Notably, there was an increase in the use of isoflurane and of injectable anaesthetic combinations such as ketamine/xylazine, whereas the use of ether and methoxyflurane decreased.     

BVOCs: plant defense against climate warming?

Plants emit a substantial amount of biogenic volatile organic compounds (BVOCs) into the atmosphere. These BVOCs represent a large carbon loss and can be up to approximately 10% of that fixed by photosynthesis under stressful conditions and up to 100gCm(-2) per year in some tropical ecosystems. Among a variety of proven and unproven BVOC functions in plants and roles in atmospheric processes, recent data intriguingly link emission of these compounds to climate. Ongoing research demonstrates that BVOCs could protect plants against high temperatures. BVOC emissions are probably increasing with warming and with other factors associated to global change, including changes in land cover. These increases in BVOC emissions could contribute in a significant way (via negative and positive feedback) to the complex processes associated with global warming.