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Introduction: The adolescent years represent a key period for the development of musculoskeletal complaints (MSC) and the differences between boys and girls. We evaluated the prevalence and course of MSC and factors associated with MSC while growing up from age 11 to age 20. Methods: Questionnaire-based data at age 11 (n = 2,638), age 14 (n = 2,517), age 17 (n = 2,094) and at age 20 (n = 2,206) from the ongoing Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort were analyzed. MSC refers to pain of lower back, upper- and/or lower extremities. A multivariable logistic regression analysis was used to evaluate a number of factors in relation to persistent pain (pain reported at three out of four measurements). Results: Prevalence of MSC increased from 14.2% at age 11 to 22.1% at age 20 for boys, and from 17.4% at age 11 to 37.9% at age 20 for girls. Persistent pain was found among 5.1% of the boys and 16.5% of the girls. Being bullied, sleeping problems and tiredness during the day were significantly associated with persistent pain, in both boys and girls, while the latter two were more prevalent among girls. Self-reported (sports-) accidents, and among girls also early onset of puberty, were also significantly associated with persistent pain, but lifestyle factors, such as physical activity and smoking, were not. Conclusion: The prevalence of MSC increases during adolescence, with a widening gap between boys and girls. The factors associated with MSC are similar in boys and girls, though the prevalence of some of these differ by sex. Significance: Measuring a group of youngsters 4 times between age 11 and 20 shows an increase in the percentage reporting musculoskeletal complaints (MSC) with a widening gap between girls and boys, with more pain among girls. Boys and girls do hardly differ with respect to factors associated with MSC, being mainly psychosocial factors and (sports) accidents.

Dissertation, Universität Duisburg-Essen, 2016 In the last decade, Germany has seen a significant increase in the number of female physicians. Literature on the topic suggests that this so called “feminization of medicine” will engender changes in the profession’s structure and the practice of medicine, resulting in an augmenting demand for part-time work, more women in high level positions and a stronger patient-centered and humane care. In order to analyze how feminization has influenced medicine, I conducted qualitative, semi-structured interviews with 21 male and female physicians holding diverse positions in a department of Surgery, a Breast Center and an Internal and Integrative Medicine department of a hospital in the Ruhr area in Germany. Using qualitative content analysis as an analytical framework, this thesis explains that an increase in the number of women doctors has taken place in the departments, but that this has not yet caused for major transformations to come about. Due to the gendered substructure of the departments, part-time work, with the exception of the complementary and alternative medicine unit in the Breast Center, is difficult to accomplish as is the compatibility of work and family life. Furthermore, clear guidelines on the provision of care leave little room for change in the practice of medicine. Most physicians do not see room to alter matters, with which organizational structures, cultures and practices in the distinct departments are in many facets reproduced instead of transformed. It is, however, not the case that the feminization process has not engendered any change at all. But modifications are only allowed when consonant with the dominant organizational culture, structures and prevalent gender stereotypes. As this thesis shows, the increase in female physicians has thus not automatically caused for qualitative changes to take place. It is rather the interplay between the agency of the physicians and organizational cultures and structures that determines how the increase of female physicians is affecting the organization and practice of care. In den letzten Jahren hat Deutschland einen deutlichen Zuwachs an weiblichen Ärzten erlebt. Gemäß der Literatur zur „Feminisierung der Medizin“ wird der Zuwachs an weiblichen Ärzten die Strukturen im Krankenhaus und die Praxis der Medizin verändern und zu mehr Teilzeitstellen, zu mehr Frauen in Führungspositionen und zu einer humaneren und stärker patientenzentrierten Versorgung führen. Um den Einfluss der Feminisierung auf die Medizin zu analysieren, führte ich qualitative, semi-strukturierte Interviews mit 21 Ärzten und Ärztinnen in verschiedenen Positionen in einer chirurgischen Abteilung, einem Brustzentrum sowie einer Abteilung für Innere und Integrative Medizin in einem Krankenhaus im Ruhrgebiet in Deutschland durch. Unter Verwendung von qualitativer Inhaltsanalyse erläutert diese Thesis, dass es einen deutlichen Anstieg des Ärztinnenanteils in den Abteilungen gegeben hat, aber dass dieser nicht zur großen Transformationen führte. Mit Ausnahme der Sektion der komplementären und alternativen Medizin des Brustzentrums, ist Teilzeitarbeit sowie die Vereinbarung von Arbeit und Familie wegen der gendered Substruktur der Abteilungen schwierig zu verwirklichen. Außerdem lassen klare Leitlinien in der medizinischen Versorgung die praktische Anwendung betreffend wenig Raum für Veränderungen. Dieses führt dazu, dass die Organisationsstrukturen und -kultur und die medizinischen Anwendungsverfahren der Abteilungen in den meisten Fällen reproduziert statt geändert werden. Es ist jedoch nicht so, dass der Feminisierungsprozess gar keine Änderungen nach sich gezogen hat. Die Modifikationen sind allerdings nur erlaubt, wenn sie mit der dominanten Organisationskultur und den generellen Stereotypen harmonieren. Die gestiegene Zahl an Ärztinnen selbst hat also nicht direkt für qualitative Änderungen in die Abteilungen gesorgt, sondern vielmehr bestimmt das Zusammenspiel zwischen ärztlichem Agens und der Organisationsstruktur und –kultur den Effekt der Feminisierung auf die Organisation und die Praxis der Medizin.