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PubMed1996

Population and women's reproductive health: an international perspective.

This paper gives a brief overview of current world population or demographic issues, followed by a discussion of the ICPD proceedings and various notable aspects of the ICPD Programme of Action. It then focuses on six of the most pressing reproductive health concerns facing women today: gender inequalities, access to contraceptive services, sexually transmitted diseases (including HIV), maternal mortality, unsafe abortion, and adolescent pregnancy. Because the ICPD Programme of Action is intended to have far-reaching consequences for each of these issues, it is taken as a focal point of analysis.

Abortion, Legal↗
PubMed1993

Preventing unintended teenage pregnancies.

A review of the literature on unplanned and teenage pregnancies was undertaken for four District Health Authorities. This work was carried out within a national context of increasing conception rates for teenage women aged 16 and under and in the knowledge that pregnant teenagers and their children tend to have poor life chances. The Health of the Nation White Paper has now focused attention on this by the inclusion of a target to reduce pregnancies to under 16-year-old women by half. To achieve this, health authorities need some understanding of the types of services which might be effective. Whilst there is limited evaluative work on the effectiveness of services for young people in this country, international comparisons suggest that some methods for reducing unintended teenage pregnancies may be more effective than others. The specific service issues identified are the need for advice and support pre-conceptually, during pregnancy and after abortion/birth; the need for easier access to contraception; the need for improved information on risky behaviour--particularly relating to pregnancy, sexually transmitted diseases, HIV/AIDS and substance abuse, and the need for improved medical and social care for pregnant teenage women. The most effective approaches for preventing unintended teenage pregnancy would appear to be the development of comprehensive advisory and family planning services, including sex education and the commitment by central and local government to tackle the adverse socio-economic factors which are associated with teenage pregnancy.

Adolescent↗
PubMed1992

The untold story: how the health care systems in developing countries contribute to maternal mortality.

This article attempts to put together evidence from maternal mortality studies in developing countries of how an inadequate health care system characterized by misplaced priorities contributes to high maternal mortality rates. Inaccessibility of essential health information to the women most affected, and the physical as well as economic and sociocultural distance separating health services from the vast majority of women, are only part of the problem. Even when the woman reaches a health facility, there are a number of obstacles to her receiving adequate and appropriate care. These are a result of failures in the health services delivery system: the lack of minimal life-saving equipment at the first referral level; the lack of equipment, personnel, and know-how even in referral hospitals; and worst of all, faulty patient management. Prevention of maternal deaths requires fundamental changes not only in resource allocation, but in the very structures of health services delivery. These will have to be fought for as part of a wider struggle for equity and social justice.

Abortion, Legal↗
PubMed1993

Experiences of legal sterilization in Scandinavia.

The three Scandinavian countries--Denmark, Norway and Sweden--all legalized voluntary sterilization in the 1970s. Previous legislation had been very restrictive, limiting access to certain defined minority groups. During the two decades with this new possibility, sterilization has been accepted as a good contraceptive alternative, equally accessible for men and women above age 25 years. The sterilization frequency varies considerably between the three countries, being most popular in Norway and Denmark. The proportion of sterilization in males versus females is 40% in Denmark, 25% in Norway and 20% in Sweden. Published follow-up studies point out risk groups for regret of the intervention, and underline the need for good preoperative counseling. The overall results are very positive.

Counseling↗
PubMed1992

Maternal mortality in the Thyolo District of southern Malawi.

The Sisterhood Method, a community-based survey technique, was used to estimate the Life Time Risk of a woman dying a maternal death in Southern Malawi. With this figure, the maternal mortality ratio for that area was calculated to be 409 deaths per 100,000 live births. The 4124 adults interviewed reported 150 maternal deaths in sisters. An in-depth questionnaire was then used to determine that 56% of these deaths occurred outside a health facility, largely due to lack of transportation or poor access to fixed health care facilities; 25% died from excessive hemorrhage; 20% from obstructed labour; 18% from abortion; 13% from sepsis; while eclampsia accounted for only 4% of the maternal deaths. This field experience with the Sisterhood Method technique combined with an in-depth questionnaire for determining causes of maternal deaths has provided useful information in a simple and cost-effective manner for use in planning intervention strategies designed to decrease maternal mortality.

Adolescent↗
PubMed1991

Sterilization acceptance and regret in Thailand.

The prevalence of sterilization increased steadily in Thailand from 1969/70 to 1984, but remained unchanged over the period 1984-87. This paper uses data from the 1987 Thai DHS to examine sterilization acceptance and regret. The prevalence of sterilization increases with both the number of children and with the age of the woman. Among women with two or more children, there is a positive association between education and wealth, and tubal ligation, but there is no correlation between education and wealth and the percentage of husbands with a vasectomy. Women whose last delivery was in hospital were more likely to have been sterilized than were women with a home delivery, and among women with a hospital delivery, those who had a cesarean section were more likely to have been sterilized than were women with a vaginal delivery. Both accessibility to medical facilities and medical problems apparently play a role in affecting who gets sterilized. The percentage of women who reported that they regretted that either they had gotten sterilized or that their spouses had gotten sterilized was 11% but regret was higher in cases in which the wife had had surgery (12%) than in cases in which the spouse had had a vasectomy (8%). This difference persisted even when other variables were introduced to examine the correlates of regret (number of children at time of sterilization, subsequent death of a child, whether sterilization was done at time of CS, residence of the respondent) using multiple classification analysis. Perhaps when women themselves are sterilized, they attribute subsequent problems in health to the operation, whereas such changes cannot be attributed to the vasectomy of their husband.

Adolescent↗
PubMed1988

Vaccination strategies in developing countries.

By 1990 it is hoped that all of the world's infants will have access to immunization services and that these services will then continue indefinitely. The link between people and health services, including immunization, can only be forged and maintained by an effective system of delivery and support to all health workers. A careful choice of strategies for this delivery system and an understanding of local cultural attitudes and behaviour is vital if this link is to be effective. Health workers will have to be trained and then supported in the field by regular contact with their supervisors. They will also need continuous, reliable, predictable and adequate supplies of equipment, drugs, vaccines, fuel and money, including salaries. Immunization is cost effective as a health intervention, but an effective programme of immunization can contribute much more than just vaccines, if it is developed in the context of primary health care (PHC) as originally proposed in 1978 at the conference in Alma Ata.

Child, Preschool↗
PubMedDate not supplied

The visible embryo project: embedded program objects for knowledge access, creation and management through the World Wide Web.

We have designed a prototype knowledge management online environment for the biomedical sciences which integrates access to online representations of the scientific literature, bibliographic databases, high-performance visualization technologies, large-scale scientific databases, and tools for authoring new-generation scientific publications. This system will provide widespread access to its resources by using the World Wide Web for its underlying architecture. This system expands upon our Weblet Interactive Remote Visualization (IRV) server technology to produce a set of dedicated Internet "visualization servers" which provide interactive control of real-time visualizations from the Visible Embryo Project database from within Web pages viewed with our WebRouser software package. This system will be used to develop a set of prototype applications for both online education of medical students in developmental anatomy and for an interactive patient education system for expectant parents. We recognize that knowledge represented by these national resource databases is not static, therefore it is essential to include tools for both the creation of new "compound documents" which incorporate embedded objects, as well as for managing the peer-review of scholarly publications, in order to ensure the integrity of new knowledge as it is added to these databases in the future. We have therefore begun to design integrated tools for our system which facilitate both the creation of and the validation of new generations of scientific knowledge.

Anatomy, Cross-Sectional↗
PubMed1992

Causes and consequences of increase in child survival rates: ethnoepidemiology among the Hmong of Thailand.

The Hmong "hill tribe" minority in Thailand has much higher exposure to factors usually associated with risk of child mortality (high fertility, low status of women, low education, less use of modern medical care for births, exposure to warfare, economic and physical disruption, and poor hygienic conditions) than the rural ethnic Thai population. Nonetheless, infant mortality has declined from over 120 per 1000 to under 50 per 1000 live births among both these populations in the past 30 years. The reason for the rapid increase in child survival among the Hmong appears to be better access to and more use of modern curative and preventive medical care associated with road construction rather than major changes in social or hygienic conditions. Conventional wisdom suggests that high fertility is both a cause and a consequence of high infant and child mortality and that parents will not reduce fertility until they see that mortality has declined. Most Hmong parents recognize the decline in child mortality and attribute it to better access to modern medical care. Most Hmong parents also say that, if they were starting to have children now, they would want to have fewer children. Fear of child death is infrequently mentioned as a motive for having more children, and the perceived decline in child mortality is rarely mentioned as a reason for reduced fertility. Most Hmong parents explain their desired family size in terms of economic conditions rather than perceived risk of child mortality. Results of this study suggest that fertility and child mortality can vary independently of one another and that major reductions in child mortality can be accomplished without waiting for major social changes (e.g., improved education or status of women) or major reductions in fertility.

Child Health Services↗
PubMed1984

Retirement preparation programs: differentials in opportunity and use.

Two issues rarely addressed in the retirement planning field are (a) the proportion of older workers who participate, or have the opportunity to participate, in retirement preparation programs; and (b) socioeconomic differentials in access to such programs. Data from the National Longitudinal Surveys of older men were used to investigate these two issues. The data indicate that fewer than 4% of this sample of men aged 60 to 74 in 1981 had participated in a retirement preparation program. Logistic multiple regression analysis indicated that level of education, occupational status, government employment, and private pension coverage were positively related to the likelihood of participation as well as the likelihood of opportunity to participate. Conclusions from this analysis are (a) very few older men are ever exposed to retirement preparation programs and (b) those who would seem to benefit most from preparation programs, low status and low income workers, are the least likely to have access to these programs.

Aged↗
PubMed1996

Software for genetic linkage analysis: an update.

Recent developments in human genetic linkage analysis have included the appearance of new software and collections of data and program resources, accessible by means of the Internet. Many of these new programs and collections are described, including their availability, literature background, and specific technical information.

Computer Communication Networks↗
PubMed1978

A problem orientated information system.

It has been suggested several times that care of patients with medical problems is not carried out in a consistent manner. Emergency medical care is most usually given by junior medical staff. It seems possible that their inexperience may further increase the inconsistency of care given. An information system HOISS (House Officer Information and Scheduling System) is described. It consists principally of a data-base of 80 clinical problems and a suite of programs to access the data-base. There is also a scheduling program which prints-out a worksheet of tests needed to be done that day. A review of the care of 86 patients is given. It is seen that there is considerable variation in the investigations done for a particular clinical problem. Also routine tests are not asked for and many investigations are done which cannot be justified from the patients condition. The results of five months experience with the system are presented. It is shown for the one problem considered that management was more consistent, the routine tests were done more regularly and there were less spurious tests performed.

Emergency Service, Hospital↗
PubMed1990

Screening, diagnosis, and management of dyslipoproteinemia in children.

The authors provide an extensive and comprehensive review of dyslipoproteinemia in children. An effective program for CVD reduction in this population will include an accessible screening program to identify high-risk children, high-quality measurements of TC and LP-C, careful follow-up of screening results with multiple measurement to classify risk status and diagnose primary dyslipidemia, a key role for family and education, and consistent and long-term follow-up for diet and drug adherence, efficacy, and safety.

Adolescent↗
PubMedDate not supplied

Fertility policy and family planning in the Arab countries.

An increasing number of Arab countries are instituting family planning programs to lower their populations' high fertility rates. This article examines Arab governments' perceptions of their countries' fertility situation, their desire to intervene in order to reduce or increase the rate of population growth, and the measures they have taken to influence the level of fertility. Special attention is given to family planning programs and access to methods of fertility regulation. A combination of stronger program effort and improved socioeconomic conditions account for much of the variation in contraceptive prevalence rates in 11 countries. Socioeconomic setting and political factors are found to be of primary importance in determining Arab fertility policies.

Family Planning Services↗
PubMed1995

Medical decision support: experience with implementing the Arden Syntax at the Columbia-Presbyterian Medical Center.

We began implementation of a medical decision support system (MDSS) at the Columbia-Presbyterian Medical Center (CPMC) using the Arden Syntax in 1992. The Clinical Event Monitor which executes the Medical Logic Modules (MLMs) runs on a mainframe computer. Data are stored in a relational database and accessed via PL/I programs known as Data Access Modules (DAMs). Currently we have 18 clinical, 12 research and 10 administrative MLMs. On average, the clinical MLMs generate 50357 simple interpretations of laboratory data and 1080 alerts each month. The number of alerts actually read varies by subject of the MLM from 32.4% to 73.5%. Most simple interpretations are not read at all. A significant problem of MLMs is maintenance, and changes in laboratory testing and message output can impair MLM execution significantly. We are now using relational database technology and coded MLM output to study the process outcome of our MDSS.

Academic Medical Centers↗