[Bulimia nervosa]. / Bulimia nervosa.

Bulimia nervosa (BN) is a relatively new syndrome occurring particularly in young women. The gender ratio is about 10:1. The disease is becoming more common especially in the Scandinavian countries. The symptoms are episodes of binge eating followed by weight regulation. Generally, weight reduction is the provoking factor. The disease is estimated to occur in 3-5% of Danish women between the age of 14 and 24 years, but also in an unknown number of older women. Several factors increase the risk of BN: high body mass index, sociocultural circumstances, such as a "drive for thinness", and psychopathological conditions, for instance low self-perception, perfectionism, and a failing internal authority; presumably there is a genetic vulnerability. BN has a number of serious somatic consequences, as well as dental damage. If left untreated, the symptoms seem to persist, whereas the results of never treatment indicate a high degree of recovery. There are thus many reasons in favour of intensifying and increasing the provision of treatment options, as well as a need for prevention.

[Attitude of general practitioners to the importance of gender and diet in disease prevention]. / Praktiserende laegers holdning til kønnets og kostens betydning ved sygdomsforebyggelse.

Three hundred and seventy-four general practitioners (GPs) in Denmark filled in a questionnaire on attitudes to include information on gender and diet in the strategy for prevention of coronary heart disease, cancer, osteoporosis, and overweight/underweight. Risk factors for disease in general were ranked as follows: smoking, alcohol, stress, diet, physical exercise, heredity and hygiene. The patients' lack of motivation, insufficient time for each patient, and inadequate knowledge about nutrition were stated as barriers to dietary counselling. The GPs stated that the gender of the patient was important only to the counselling on osteoporosis. Lack of time and insufficient knowledge were perceived as barriers for including gender specific issues in prevention. It is concluded that GPs consider dietary counselling important but lack time and knowledge. The results point at a need for better pre- and postgraduate training in nutrition, and for a better reimbursement system for time spent on prevention.

[Prevention in general practice. Are female and male patients treated the same way? A questionnaire study]. / Sygdomsforebyggelse i almen praksis. Gøres der forskel på kvinder og maend? En spørgeskemaundersøgelse.

Three hundred and seventy-four general practitioners (GPs) in Denmark filled in a questionnaire on practices regarding prevention of coronary heart disease (CHD), cancer, osteoporosis, and overweight/underweight. Half of the GPs were questioned about the issue of prevention based upon female case stories and the other half on male case stories with identical wording. The GPs more often in relation to: Prevention of CHD gave dietary counselling and recommended weight loss to slightly overweight male than female patients. Prevention of cancers gave dietary counselling and recommended weight loss and increase of exercise to female than to male patients. Prevention of osteoporosis recommended a supplement of calcium and vitamin D to female than to male patients. Treatment of underweight recommended weight gain and discussion of psycho-social issues to underweight female than male patients. In conclusion, GPs distinguish between men and women in relation to prevention strategies in general practice. There is a need for well-described prevention and action strategies with relevant gender differentiation for use in general practice.

[Psychological consequences of induced abortion]. / Psykiske følger af provokeret abort.

One hundred and thirty consecutive women were interviewed about the development of psychological symptoms related to induced abortion two days before and four months after the abortion. Sixty-one (47%) participated in the second interview. Of the 61 women, 52% were psychologically influenced before the abortion to an extent which indicated severe crisis or actual psychiatric illness. Four months after the abortion 13 of these women were still psychologically affected. Furthermore, five women who were not affected before the abortion had developed psychological problems. Among ten of these women (16%) the physiological problems could only be related to the circumstance in connection with the abortion. For a number of women (30%) the abortion had a negative influence on their relationships and their sex lives, whereas other claimed that their relationship had become closer because of their reactions towards the abortions. In spite of these conditions all women indicated that their decision about the abortion had been the correct one under the given circumstances.

PIP: Between March 1, 1991, and April 1, 1992, a questionnaire-based investigation was carried out among 361 selected consecutive women seeking abortion in connection with a study at the Gynecological Ward of Hillerod Hospital, Copenhagen. 142 women were also asked to participate in an interview 4 months after the abortion; 12 did not want to collaborate, which left 130 women. 61 were later interviewed and the remaining 69 were lost to follow-up. The questions related to their demographic and socioeconomic situations, contraceptive behavior, decision-making processes, and reasons for choosing abortion. The participants also filled out a rating scale describing 29 psychological symptoms. 92% of the subjects had a steady partner. 29 (48%) of the 61 women were not psychologically affected before the abortion, but 32 (52%) were to an extent indicating severe crisis or actual psychiatric illness. After the abortion procedure 43 (70%) were not psychologically affected, but 18 (30%) were. 13 of these continued to be psychologically affected after the abortion. 5 women who were not affected before the abortion had developed psychological problems. 4 of these women had 13 or more symptoms of psychological disease after the abortion. Among 49 (80%) women the number of symptoms averaged 10.2 before abortion and 4.6 after the abortion. For the remaining 12 women the number of symptoms increased. Among 10 of the women the psychological problems could only be related to the circumstances in connection with the abortion. 17 (28%) women admitted guilty feelings 4 months after the abortion. 13 (21%) women reported that after abortion they were afraid to get pregnant again, and 6 felt less libido at one time or another. For a number of the women (30%) the abortion had a negative influence on their relationships and their sex lives, whereas others claimed that their relationships had become closer because of their reaction towards abortion. In spite of the problems all women indicated that their decision to have an abortion had been right under the circumstances.

[Use of contraception and reasons for choosing abortion among abortion applicants]. / Abortsøgendes praeventionsbrug og årsager til valg af abort.

The object of this study was to describe a group of women applying for legal abortion in relation to their use of contraception and reasons for choosing an abortion. During a period of 13 months (1991-92) a questionnaire was distributed to women applying for legal abortion at Hillerød Hospital in Denmark. Three hundred and thirty-nine women participated. Fifty-nine percent of the women had become pregnant although they had used contraception. As seen in other studies, women still state demographic factors as their most important reasons for choosing an abortion. Women with two or more children do not want to have more children. Single women do not want children without being in a stable relationship. Furthermore occupation and education were frequently stated as important reasons for having an abortion. Economy and housing were not main reasons but contributory factors. Thirty percent of the women expressed ambivalence about the choice of abortion at the time when the abort was due.

[Induced abortion after the 12th week of pregnancy in the county of Arhus 1993-1994. Psychological consequences]. / Abortus provocatus efter 12. svangerskabsuge i Arhus Amt 1993-1994. Psykiske konsekvenser.

The records of all women applying for permission to have an abortion performed after the 12th week of pregnancy during a one-year period in the County of Aarhus were continuously reviewed, and the women who had the abortion performed due to psychosocial reasons were interviewed with a questionnaire at the time of the abortion and again four months later. Of the 76 women who applied for permission for a late abortion the following were excluded from the study: 31 who had the abortion because a malformed child was suspected, six women who did not have the abortion although permission had been given, five women who did not receive permission, four who were under 18 years of age, one who had a miscarriage, 10 who were from another country of origin and did not understand Danish and finally four women who were allowed an abortion on a medical indication and who were either in hospital or in jail. Fifteen women were questioned concerning their age, length of pregnancy and psychological and social histories and were asked to fill out a depression scale. The data showed that none of them had planned their pregnancy and they had had no symptoms of pregnancy until the time at which they applied for the abortion. None of them regretted the abortion afterwards; half of the women were under psychological strain at the time of application, and a few of them had even more psychological symptoms four months after the abortion. Although they had many social problems, physical complications and psychological problems only a few of the women had seen a doctor in the four month period between the abortion and the follow-up.

PIP: The purpose of this investigation was to determine the health status of women at the time of and four months subsequent to induced abortion for psychosocial indications during the period of November 1, 1993-October 31, 1994. Data were collected in Arhus County, Denmark, from among women who sought abortion after the 12th week of pregnancy. The women were over the age of 18 and had to speak Danish to be able to answer a questionnaire about their age, the week of gestation, the reason for abortion, and their psychological symptoms on a rating scale at the time of seeking abortion and four months later. In all 76 women sought abortion after the 12th week of pregnancy, 31 because of suspicion of chromosomal aberrations. Of the rest, 6 chose to give birth although permission was granted for an abortion, 5 did not get permission, 4 were under 18 years of age, 1 had a miscarriage, 10 did not understand Danish, and 4 had permission on medical grounds. 8 of the 23 women who qualified for the evaluation refused to participate, and 5 declined to participate in the follow-up investigation, thus only 10 women took part in both analyses. About half of all the abortion seekers who answered the questionnaire were in the 20-34 year age group. 13 of the women were in the 12-15th week of pregnancy, but one was in 19th and 1 in the 21st week. One-third of the women lived together with their partner and another one-third did not have a steady partner. Half of the partners were students facing examinations. One-fourth of the women had other children and 4 of the women had experienced a previous abortion. 9 of the 15 admitted that their financial situation was serious or bad and 7 women acknowledged that this had an impact on choosing abortion. None of the 15 women had planned the pregnancy and all felt that the abortion was the right decision.

[The effect of gender on the physician's role. Attitudes and expectations of medical students examined by a questionnaire at the start of their studies]. / Kønnets betydning for laegerollen. Loegestuderendes holdninger og forventninger belyst ved spørgeskemaundersøgelse af studiestartere.

A questionnaire was given to 254 medical students matriculated in 1992/93 concerning their motivation for wanting to become a doctor, attitudes towards which qualities a doctor should have and their potential choice of medical specialty. The analysis focuses on whether answers are relation-orientated (i.e. directed towards relations to others) or autonomy-orientated (i.e. directed towards rationality and independence). The results show that motivations for becoming a doctor are both relation- and autonomy-orientated. Most students expect the doctor to both be able to relate to the patient and be professionally competent. No gender differences could be demonstrated concerning motivations for becoming a doctor or which qualities a good doctor should possess. Significant gender differences were displayed concerning choice of specialty, most women aiming towards relation-orientated specialties and most men aiming towards autonomy-orientated specialties. It is concluded that the growing proportion of women doctors could change the medical profession towards becoming more patient- and relation-orientated, however their choice of relation-orientated and lower prestige specialties could result in less overall influence than one might otherwise expect.

[Occurrence of bulimic behavior among a group of Danish medical students]. / Forekomsten af bulimisk adfaerd blandt en gruppe danske laegestuderende.

As part of a prospective survey of Danish medical student's conditions we looked into the question of the frequency of bulimic behaviour in this group of students. One hundred and ninety-one (75.2%) of 254 students matriculated during 1992-1993 answered a minor structured questionnaire in 1994 about their eating habits, weight and weight control and perception of their bodies. Body mass index was calculated. Forty-five percent of the women and 15.2% of the men admitted to binge-eating, 28.0% of the women and 9.1% of the men admitted to binge-eating together with some kind of weight regulation. Fifty-six percent of the women and 25.8% of the men used some weight regulating procedures, most often exercising and eating less of sweet and fattening foods. Only a very few admitted to self-induced vomiting. Binge eating was clearly related to suppressing depressive and negative feelings. Almost 30% of the women were underweight (BMI < 20) but felt themselves to be a normal weight. The male students seemed to be more satisfied with their body and psyche than the women who more often felt overweight and were prone to binge-eating when they felt depressed, and consequently had to regulate their weight in order to live up to their ideals. In order to elucidate the magnitude of the problem of bulimic behaviour and the consequences, we need further surveys of other groups in the Danish population.

[The social recruitment of medical students at Copenhagen University 1992/1993]. / Den sociale rekruttering af laegestuderende i 1992/1993 ved Københavns Universitet.

As part of a prospective survey of medical students' conditions and of the different kinds of influence they are subjected to during their study periods, we looked into the question of from which social strata the students were recruited. Two hundred and fifty-four (79%) of 323 medical students matriculated during the summer of 1992 answered a structured questionnaire forwarded to them. One hundred and thirty-one (52%) medical students were recruited from the highest social class (I), whereas only 19 (7%) were recruited from the lowest social class (V). In comparison, the underlying population in the age groups relevant for the survey is made up as follows: 7% in social class I and 20% in social class V. A comparison with earlier surveys shows that only insignificant changes in the medical students' social class profiles have taken place in spite of the introduction of better possibilities of financing medical studies irrespective of social class affiliations.