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PubMed1998

The characteristics and residential situations of people with severe intellectual disability and the most severe challenging behaviour in Wales.

A total population study of people in Wales with severe intellectual disability and the most severe challenging behaviour was undertaken to identify their characteristics, and the nature of their residential arrangements and service support. Forty-one participants were identified: five living in family homes, 17 in community housing, 17 in hospitals and two in hostels. The family home group had slightly higher adaptive behaviour scores than residents in community housing. Both groups had significantly higher scores than the hospital and hostel residents combined. Assessments of challenging behaviour showed the groups to be similar and to have a considerable range and extent of severely problematic behaviour. Co-occurrence of several forms of frequent severe problem behaviour was the norm and there was a marked association with social impairment. The five people living in their family homes had nominated service keyworkers, but reported professional input was low. The residential situations comprised two main service types: (1) traditional services, which were characterized by large living unit and facility size, atypical architectural design, relative isolation from the community, a greater level of buildings adaptations, low staff:resident ratios, a relatively high percentage of qualified staff, and a relative absence of systematic approaches to goal planning and structured activity; and (2) new community houses, which were characterized by small size, domestic design, location within the community, a lower level of buildings adaptations, much higher staff:resident ratios, and less emphasis on qualified staff but a greater emphasis on systematic working methods. Community settings were similar in having 'specialist' resident groupings based on challenging behaviour or conditions like autism in which challenging behaviours are common. A policy to provide for people with these characteristics being resettled from traditional settings in this way seems to have been established.

Adult↗
PubMed1989

Contraceptive prevalence and continuation: a longitudinal analysis of traditional and other method users in the Philippines.

Contraceptive prevalence rates and estimates of continuation rates are derived from unique longitudinal data on post-partum behaviour collected in the Cebu region of the Philippines. Continuation rates vary by base-line and time-varying socioeconomic characteristics for certain contraceptive methods and for using no contraception. Calendar rhythm users have a much lower relative continuation rate than has been found in cross-sectional samples. For women who use a contraceptive method, breast-feeding does not appear to influence contraceptive continuation, but for those who use no methods, breast-feeding appears to substitute for other forms of contraception. Profiles by socioeconomic characteristics of those who continue to use each type of contraceptive method and who use no method could be used to direct family planning programmes towards population sub-groups. The results suggest that for women wishing to postpone a pregnancy, a family planning programme aimed at the young and less educated could effectively increase contraceptive use and continuation.

Adolescent↗
PubMedDate not supplied

Birth control discontinuance as a diffusion process.

This paper applies the diffusion of innovations model to the study of the birth control discontinuance of first-time users in the Dominican Republic. Two sets of factors are examined: social characteristics of the adopters are used to test Rogers's and Shoemaker's contention that discontinuers have more traditional values than continuers; and the adoption decision process is analyzed to identify the relationship of communication factors to discontinuance. Although number of children and experience of method problems were the major determinants of discontinuance, unfavorable information from friends and other birth control users was a significant factor. Rumor was found to have little effect on a women's decision to continue or discontinue.

Adult↗
PubMed2001

[Norwegian medical students abroad--career plans, personality, smoking and alcohol use].

BACKGROUND: More than 30% of Norwegian physicians have graduated from medical schools outside Norway, and the number of Norwegian students that attend medical schools abroad is increasing, particularly in Hungary, Poland and the Czech republic. There is a need to know more about these future Norwegian doctors, what their motives and plans are, and how they differ from students at home. MATERIAL AND METHODS: A postal survey was carried out among all 1,198 Norwegian medical students that were in the files of the State Education Loan Fund by August 1998. The questions covered reasons for going abroad, academic and non-academic outcome, satisfaction, specialty and job preferences, possible motives for career choices, personality characteristics, smoking status and alcohol use. Comparable data were available from previous studies of medical students in Norway. RESULTS: There were 756 responses (63%). Surgery, internal medicine and paediatrics were the most popular specialties. Family medicine and psychiatry seem to be less likely specialties for students abroad than for students at home. Traditional gender differences, e.g. interest in aiming for a leadership position, were present and did not differ from those seen among students in Norway. Students abroad were more oriented towards leadership and prestigious specialties, less preoccupied with the possibility of making medical mistakes, and less interested in medico-policial issues than their counterparts at home. Their personality profiles seemed more robust than those of students in Norway. On the other hand, they smoked much more frequently and had a higher risk of alcohol-related problems. INTERPRETATION: Norwegian medical students abroad do not particularly prefer specialties like general practice and psychiatry, where the demand for medical manpower is highest. They seem to have quite traditional preferences according to gender.

Alcohol Drinking↗
PubMedDate not supplied

The effect of the sex of interviewers on the quality of data in a Nigerian family planning questionnaire.

Traditionally, female interviewers have been preferred to men for conducting fertility and family planning surveys. However, in West Africa, evidence for their superiority over male interviewers is mixed. In Nigeria, as part of a four-state pretest of the national family planning questionnaire, an experimental design was incorporated to quantify effects of the sex of the interviewer. In one state, reinterviews were also performed to measure the reliability of responses. In the conservative northern state of Kano, the use of male interviewers was problematic. However, in the other three states, only weak evidence was found to mitigate against the use of male interviewers. In fact, in two states, the proportion of respondents reporting knowledge of several contraceptive methods was significantly higher when male interviewers conducted the survey. Respondents' reports of contraceptive use were very unreliable for interviewers of both sexes.

Adolescent↗
PubMed1993

Long-interval treatment regimen with a desogestrel-containing oral contraceptive.

A randomized multicenter study was performed in order to investigate the acceptance of a low-dose OC (30 micrograms of ethinyloestradiol and 150 micrograms of desogestrel), using a 9 weeks on and 1 week off schedule (prolonged regimen, n = 198), compared to a traditional 3 weeks on, 1 week off schedule (standard regimen, n = 96). Haemoglobin and blood pressure remained the same in both groups during the study. No significant differences were found in body weight changes between the two groups. There was significantly more breakthrough bleeding and spotting in the group with prolonged regimen than in the group with standard regimen, but both breakthrough bleeding and spotting decreased during the trial. Irregular bleeding was significantly less in women who were already using OC, compared to "new starters." No serious side effects occurred. Significantly more women stopped the trial because of bleeding problems in the group with prolonged regimen, while there were significantly more women who stopped the trial because of headache in the group with standard regimen. After completing 12 months, or after premature withdrawal from the study, each women completed a questionnaire. Sixty-three per cent of the women preferred the studied alternative and twenty-six per cent preferred the traditional OC.

Adolescent↗
PubMedDate not supplied

Sexual networking in the Ekiti district of Nigeria.

The confirmation of a significant number of HIV-positive persons and some deaths due to AIDS in Nigeria has rendered more urgent the study of sexual networking, both for an understanding of the risk of HIV transmission and also that of sexually transmitted diseases, which may serve as a vehicle for HIV infection. This article reports on a research project that concentrated initially on developing both small-scale survey and anthropological methodology to a point where reliable information was obtained. The research was carried out in both urban and rural areas of Ekiti, Nigeria, a Yoruba district 150 miles northeast of Lagos. Findings are reported from both the survey of 200 men and 200 women and the supplementary specialized in-depth studies. A high level of premarital and extramarital sexual activity was shown to exist, with higher levels among men than women and in urban than rural areas. Most female extramarital relations in rural areas were occasioned by the need for material or economic assistance and were highest among the younger wives in polygynous marriages. Male extramarital relations were highest in monogamous marriages and were frequently explained by wives' periods of postpartum sexual abstinence. Polygyny and postpartum sexual abstinence were underlying social institutions that explained much of the sexual networking. Reported levels of sexually transmitted disease were high, as were beliefs that these disease could be treated successfully by traditional healers.

Adolescent↗
PubMed1996

Monitoring and evaluating managed care for children with chronic illnesses and disabilities.

OBJECTIVE: Children with chronic illnesses and disabilities are increasingly enrolling in managed care arrangements. Yet, the rapid expansion of managed care has unknown consequences for children with chronic conditions and disabilities. As managed care is likely to become the predominant mode of medical practice for children with chronic health problems, information gained from a thorough assessment of existing managed care models could be helpful in indicating adjustments and modifications that could result in improved outcomes for this population. the purpose of this article is to outline a new strategy for collecting needed information on the effects of managed care on children with chronic health problems. METHODS: We reviewed the literature on the effects of managed care on children with chronic conditions and disabilities. We identified key domains relevant to monitoring and evaluating managed care for this population. RESULTS: Two research approaches can provide helpful information for assessing the effects of managed care on children with chronic conditions. First, a monitoring strategy could be pursued in which enrollment trends in managed care, enrollee perceptions of access and satisfaction with care, and other general indicators of outcomes would be tracked over time using inexpensive and rapid turnaround data sources. Second, an evaluative strategy could be pursued using experimental or quasiexperimental designs, in which outcomes across a variety of domains for children with chronic conditions in managed care are compared with: (a) outcomes for the same children before enrollment in managed care; or (b) outcomes for similar children remaining in traditional fee-for-service settings. Evaluation and monitoring strategies should focus on outcomes in a number of domains including: (1) access to care; (2) utilization of services; (3) quality of care; (4) satisfaction with care; (5) expenditures for care; (6) health outcomes; and (7) family impact. CONCLUSION: Assessing outcomes that result from enrollment in managed care for children with chronic health problems presents a formidable challenge. The research strategy outlined in this article presents one approach to meeting that challenge. The monitoring and evaluation strategies described here would require commitment of additional resources on the part of government, private foundations, and/or health plans. Given the paucity of existing information and the stakes for children with chronic conditions and their families, investment of added resources in a comprehensive monitoring and evaluation strategy is essential.

Child↗
PubMed1984

The demographic transition.

Demographic transition is a set of changes in reproductive behavior that are experienced as a society is transformed from a traditional pre-industrial state to a highly developed, modernized structure. The transformation is the substitution of slow growth achieved with low fertility and mortality for slow growth maintained with relatively high fertility and mortality rates. Contrary to early descriptions of the transition, fertility in pre-modern societies was well below the maximum that might be attained. However, it was kept at moderate levels by customs (such as late marriage or prolonged breastfeeding) not related to the number of children already born. Fertility has been reduced during the demographic transition by the adoption of contraception as a deliberate means of avoiding additional births. An extensive study of the transition in Europe shows the absence of a simple link of fertility with education, proportion urban, infant mortality and other aspects of development. It also suggests the importance of such cultural factors as common customs associated with a common language, and the strength of religious traditions. Sufficient modernization nevertheless seems always to bring the transition to low fertility and mortality.

Birth Rate↗
PubMed1988

Trends in ectopic pregnancies and use of intrauterine devices in Lombardy, Italy 1979-1983.

The frequency of ectopic pregnancies in Lombardy (a region in Northern Italy with a population of about 9 million inhabitants) over the period 1979-1983 was estimated using the Regional Hospital Discharge Registration System, where information is collected on all discharges from public and private hospitals. The ratio of ectopic pregnancies rose from 4.43/1000 pregnancies in 1979 to 4.93/1000 pregnancies in 1982 and flattened off in 1983 (4.78/1000 pregnancies). The frequency of ectopic pregnancies increased with maternal age from 2.30/1000 pregnancies in teenagers to 6.01/1000 pregnancies in women 30-39 years old, but remained constant thereafter (5.84/1000 pregnancies in women aged 40 or older). These trends were consistent with available information on intrauterine device (IUD) sales over the same calendar period. On the basis of a random subsample of the same dataset, we evaluated by means of a case-control approach, the relative risk of ectopic pregnancy in relation to IUD use. Current IUD users had an estimated age-adjusted relative risk of ectopic pregnancy of 3.6 (95% confidence interval = 1.4-8.0) in comparison with an hospital-based control group of non-pregnant women. In etio-pathological terms, the interpretation of this finding is not obvious since it is possible that IUD users are simply less protected than pill, barrier or other traditional method users against ectopic pregnancy. Nonetheless, on a public health scale, the impact of IUD on the incidence of ectopic pregnancy should be evaluated in relative terms of comparison with other methods and their utilisation in different populations.

Adult↗
PubMed1987

Menarche and sexuality among a sample of black South African schoolgirls.

This paper starts out with the assumption that human behavior is influenced by and can best be understood when viewed against a cultural background which gives context and meaning. Thus this discussion of menarche and sexuality starts off with premarital sexual socialization. It is from this traditional viewpoint that most urban residents come. The discussion then turns to the research sample studied in Pretoria, South Africa, during April 1985. Information dealing with physical maturation, sexual knowledge, and sexual activity is included, documenting a relatively uninformed population sample which is becoming increasingly more sexually active. Four studies of the same nature, between 1943 and 1969, are used here to derive a comparative picture on age at menarche and aspects of maturation. The next part of the paper deals with South Africa's Family Planning Programme and the knowledge and attitudes of this sample of Black schoolgirls is analyzed against the work done in that program. This includes general knowledge about pregnancy and attitudes regarding birth control methods. The final section of this paper deals with the attitudes of these female students as regards sexuality and the woman's control over her own sexuality both outside and inside a marriage relationship.

Adolescent↗
PubMed1993

Determinants of neonatal mortality in central Sudan.

A follow-up study was conducted in six community health centres during the period April 1989 to March 1990 to determine the risk factors which influence neonatal survival in central Sudan. The estimated neonatal mortality rate ranged between 20.0 and 36.0 per 1000 live births per year, and the major cause of death was tetanus neonatorum (29% of neonatal deaths). The mortality rate was lowest when tetanus toxoid was received during pregnancy and the umbilical cord was cleaned by a modern hygienic method (mortality rate of 11 per 1000). In contrast, the mortality rate was highest when no tetanus toxoid was received and no or traditional cord cleaning was used (mortality rate of 62 per 1000; relative risk (RR) = 5.6, 95% confidence interval (CI) 2.0-14.9). The major predictors of neonatal mortality were tetanus, short birth-to-conception interval, multiparity, reported malaria during pregnancy, low birthweight, low maternal weight and low socio-economic status. The population attributable risks were high, and the preventable factors collectively accounted for 93.5% of neonatal mortality. Safe deliveries and wider immunization coverage are needed to control neonatal tetanus in this community. Other interventions to lower neonatal mortality in central Sudan should include accessible family planning programmes and measures to lower the incidence of low birthweight.

Birth Weight↗
PubMed2000

Contraceptive failure: levels, trends and determinants in Matlab, Bangladesh.

This study investigated the levels, trends and determinants of contraceptive use-failure in Matlab, Bangladesh, using a set of prospective data on 25,960 women of reproductive age. The data were extracted from the Record Keeping System (RKS) of Matlab for the period 1978-94. If there was any live birth during the use or within 7 months after the discontinuation of use, it was considered as a failure. The life table technique and hazard model were used as analytical tools. The results suggest that use-failure for pills, IUDs (TCu 200) and injectables and other temporary methods increased from 1978 to 1988, but began to decline after 1988. The cumulative probability of first-method failure within 1 year of method acceptance of the cohort of 1990-94 acceptors was 12.9% for pills, 2.0% for IUDs, 0.5% for injectables, 22.0% for condoms and 13.4% for 'other' methods (sampoon, foam, jelly and traditional methods). For pills, condoms and 'other' methods, the likelihood of failure declined with the duration of use; by contrast, the probability of an IUD failure increased over time, peaking at 3 years of use. The injectables maintained a low likelihood of failure regardless of the duration of use. The quality of Community Health Workers' (CHWs) performance was associated with the risk of failure of all temporary methods except condoms; women's background characteristics associated with failure varied by method. The effect of the quality of the CHWs' performance and the background variables on failure did not change much over time. It is felt that contraceptive failure deserves the serious attention of programme managers and policy makers to make the Bangladesh national family planning programme more successful.

Adult↗
PubMed2004

The Circles of Care evaluation: doing participatory evaluation with American Indian and Alaska Native communities.

Little information exists regarding mental health and special needs related to American Indian and Alaska Native (AI-AN) families. In this paper we emphasize the use of oral tradition during the Circles of Care initiative, which was essential in understanding cultural history and historical trauma of AI-ANs while giving a greater understanding of an AI-AN-based definition of severe emotional disturbance (SED). The success of these methods serves as a template for improving systems of care and may be useful in evaluation among a wide range of ethnic communities.

Adolescent↗
PubMed1997

Acute pain management clinical practice guideline: implications for nurse anesthetists.

Millions of operative procedures are performed in the United States each year. One of the greatest concerns for the surgical patient is postoperative pain. Despite traditional efforts to alleviate this pain, clinical studies indicate that postoperative pain is not relieved in most patients. The federal Agency for Health Care Policy and Research (AHCPR) developed a clinical practice guideline, Acute Pain Management: Operative or Medical Procedures and Trauma to help clinicians, patients, and patient's families understand the assessment and treatment of postoperative acute pain in both adults and children. Certified registered nurse anesthetists (CRNAs) can use the guideline to improve acute pain management within their institutions. Effective pain management can be accomplished through a collaborative, interdisciplinary approach using an individualized proactive pain control plan. Frequent assessment and reassessment of pain, use of drug and nondrug therapies, and implementation of an institution-wide program using CQI/QA methods in necessary. Implications for CRNAs include providing patient and staff education, establishing standards of care for pain management, and adapting an aggressive "no pain, much gained" clinical practice.

Acute Disease↗
PubMed1991

Reexamination of Eisen, Zellman, and McAlister's Health Belief Model questionnaire.

Eisen, Zellman, and McAlister proposed a 22-item scale to measure four Health Belief Model (HBM) constructs as applied to adolescent contraceptive behavior. Their factor analysis led them to conclude that there were several discrepancies in their proposed scales. We suggest that they were unduly pessimistic. Although their proposed scales could stand improvement, they are adequate preliminary tools. The major reason they concluded that the scales were deficient was that they applied criteria that are generally appropriate for continuous data to their inherently discrete (categorical) item response data. A secondary consideration is that confirmatory methods of factor analysis can yield results that bear more directly on their proposed organization of items than the traditional exploratory methods that they used. A reanalysis of their data suggests that their proposed scales have fewer problems than they believed they had. Our results increase the likelihood of standardizing HBM measures.

Adolescent↗