Empirical and theoretical literature suggests that stereotypical gender roles shape men's and women's health help-seeking behavior, and plays an important role in the treatment seeking delays of cardiac patients. We were interested in exploring the ways in which gender informs the experiences and help-seeking behavior of men and women who experienced the symptoms associated with acute cardiac events. We undertook 20 in-depth interviews between October 2007 and July 2008 with 11 men and 9 women recently diagnosed with an acute coronary syndrome in British Columbia, Canada. Participants were encouraged to tell their 'story' of the event that led to hospitalization and diagnosis, with a focus on the symptoms and decision making processes that occurred before and during the activation of health services: seeking the advice of others including colleagues, family members and healthcare professionals; calling 911; and attending an emergency department. Although we anticipated that distinctive patterns of help-seeking behavior aligned with stereotypical masculine and feminine ideals might emerge from our data, this was not always the case. We found some evidence of the influence of gender role ideology on the help-seeking behavior of both male and female participants. However, men's and women's experiences of seeking health care were not easily parsed into distinct binary gender patterns. Behavior that might stereotypically be considered to be 'masculine' or 'feminine' gender practice was shared by both male and female participants. Our findings undermine simple binary distinctions about gendered help-seeking prevalent in the literature, and contribute towards setting the direction of the future health policy and research agenda addressing the issue of gender and health help-seeking behavior.

We found few and variable operational definitions of PHD, despite American College of Cardiology/American Heart Association recommendations to report specific intervals. Worryingly, definitions of symptom onset, the most elusive component of PHD to establish, are uncommon. We recommend that researchers (a) report two PHD delay intervals (onset to decision to seek care, and decision to seek care to hospital arrival), and (b) develop, validate and use a definition of symptom onset. This will increase clarity and confidence in the conclusions from, and comparisons within and between studies.

Despite increasing emphasis on advance directives, there has been little methodologic work to assess preferences about the "do not resuscitate" (DNR) order. This developmental work assessed, in a non-patient group, the performance of a probability-trade-off task designed to assess DNR attitudes, in terms of framing effects and stability of preferences. 105 female nursing students each completed one of two versions of the task. In version I (n = 58), the trade-off moved to increasingly negative descriptions of the outcomes of resuscitation (decreasing chance of survival and increasing risk of brain death), whereas in version II (n = 47), the trade-off moved to increasingly positive descriptions. One week later, repeat assessments were obtained for versions I (n = 35) and II (n = 28). The DNR preference scores were lower and more stable when the task moved to increasingly positive descriptions; perhaps this version of the task tends to weaken risk aversion. These results imply that care should be used in applying a probability trade-off task to the assessment of DNR preferences, since artefactual effects could be induced.

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Background: Some symptoms commonly associated with myocardial infarction may appear as early symptoms in the absence or presence of chest pain in both women and men. Purpose: To describe the general symptoms in patients with MI and to analyze gender differences. Methods: Descriptive study with prospective data collection on 406 patients admitted to a coronary intensive care unit diagnosed of myocardial infarction by electrocardiogram, serum cardiac enzimes and clinical symptoms. General symptoms collection during the acute crisis was performed by personal interview to the patient. We adapted the "McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey" to a list of 27 symptoms, and to our language cultural context. Symptom checklist developed by D´Antono in 2006 was used to evaluate general symptoms: twenty-three-item checklist designed to assess the more subtle symptoms associated with ischemia. Interviews was performed by a group of cardiology nurses at the first day after the admission or when patient was clinically stable. Informed consent was obtained from all patients enrolled in the study Results: 98% of the patients showed any general symptoms. The average symptom onset was 5.6 symptoms (standard deviation 2.4 symptoms). The most common general symptoms in all participants during the acute crisis were: sweating (71.4%), fatigue / tiredness (71.4%), feeling of weakness (56.4%), dyspnea (50.5%) nausea (44.3%), upset stomach (29.8%), dizziness (29.6%). The differences between women and men were seen in 5 general symptoms: women were more fatigue / tiredness (women: 66.5% vs. men: 52.7%, p <0.005) than men, dizziness (women: 35.5% vs. men: 23, 6%, p <0.009), the sensation of a lump in my throat (women: 14.3% vs. men: 7.4%, p <0.025), heart palpitations (women: 9.4% vs. men: 3%, p < 0.007), and flushing (women: 7.4% vs. men: 3%, p <0.044). Conclusions: Most of the patients in the acute phase of myocardial infarction presented general symptoms. Differences were observed by gender, being more common in women of fatigue, dizziness, throat, palpitations and flushing.