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PubMed1996

Who gives advice about postpartum contraception?

Women were interviewed to determine what advice they received about postpartum contraception and what they thought of it. Only 4% of women discussed postpartum contraception antenatally. Up to 84% discussed the issue with a midwife on the postnatal ward but discussion was often felt to be brief, limited and frequently held as the mother was leaving the hospital. Obstetricians appeared to have little interest in the subject and only 50% of mothers left the hospital with supplies of a contraceptive. Almost all women discussed contraception with their general practitioner at the postnatal check but a significant number felt that the choice of method was limited to condoms or pills. The postnatal check is traditionally held at six weeks--two to three weeks after the recommended time for starting contraceptive precautions. Women with short inter-pregnancy intervals were younger, less likely to be married and more likely to default from postnatal follow-up. Pregnant women should be offered the opportunity during the antenatal period to discuss postpartum contraception with someone who has a special interest in the subject. The postnatal ward is not an appropriate setting for discussion about future contraception.

Contraception↗

PubMed2005

Lesbian families and family functioning: an overview.

OBJECTIVES: In the last 30 years a growing body of studies on lesbian parents and the development of children has been published. METHODS: Four computerized databases were identified studies for inclusion in this review of research on lesbian families, namely PsychInfo, Educational Resources Information Centre (ERIC), Medline, and the Social Sciences Citation Index. RESULTS: Forty-four empirical studies on lesbian families published between 1978 and 2003 were reviewed. In the research on lesbian families two phases were identified. To begin with, systematic studies on lesbian families focused on lesbian families with children who were born in a previous heterosexual relationship. More recently, studies included lesbian families whose children were born to the lesbian couple (planned lesbian families). In both phases, articles reporting results on children's development (such as sexual identity, emotional/behavioral development, social relationships and cognitive functioning), and parental functioning (such as mental psychological health and parenting skills). This paper presents and discusses major finding of the reviewed articles. CONCLUSION: Studies in both phases have emphasized that lesbian and heterosexual families are very much alike. However, it is the stigma of lesbianism that makes the family situation of lesbian families different. PRACTICE IMPLICATIONS: Healthcare workers should be informed about the similarities and differences between lesbian families and heterosexual families, and about the non-traditional family situation of planned lesbian families.

Adaptation, Psychological↗

PubMed2001

Combined internal medicine-psychiatry and family medicine-psychiatry training programs, 1999-2000: program directors' perspectives.

PURPOSE: Despite tremendous growth in the number of combined-training residency programs, little is known about their directorships, financing, recruitment, curricula, and attrition rates, and the practice patterns of graduates. The authors surveyed residency program directors from combined internal medicine-psychiatry (IM/PSY) and family medicine-psychiatry (FP/PSY) programs to provide initial descriptive information. METHOD: Programs' directors were determined from the American Medical Association's Graduate Medical Education Directory and FREIDA online database. Three mailings of a pretested questionnaire were sent to the 40 identified combined IM/PSY and FP/PSY residency programs. RESULTS: A total of 32 directors from 29 programs responded. Most programs were under the dual directorship of representatives from both the psychiatry department and either the internal medicine or the family medicine program. Although most directors responded that the residency program was based in psychiatry, both departments shared in administrative, recruiting, and financial responsibilities. Curricula varied widely, with limited focus on combined training experiences. Graduates (n = 41) tended to practice in academic settings (37%), where both aspects of training could be used. Others practiced in either community mental health centers or traditional private practice settings. The estimated attrition rate from combined residencies was 11%. CONCLUSIONS: Combined-training programs are directed by a diverse group of individuals, including dual-boarded physicians. Curricula vary widely, but most programs are within recommended guidelines. Further prospective studies are warranted to determine predictors of attrition and future practice plans.

Attitude of Health Personnel↗

PubMed2004

Practicing effectively in today's health system: teaching systems-based care.

BACKGROUND AND OBJECTIVES: The Institute of Medicine and the new Accreditation Council for Graduate Medical Education General Essentials have focused attention on the Undergraduate Medical Education for the 21st Century (UME-21) core content area of systems-based care. Through teaching systems-based care, medical students can learn how physicians effectively deliver and coordinate care within the health system. While medical students can be introduced to the organization, financing, and delivery of the health care system through lectures, the principles and practice of systems-based care must be reinforced through structured learning experiences during the clinical (ie, third and fourth) years. The purpose of this article is to define the undergraduate clinical content and experiences in systems-based care offered by the eight UME-21 partner schools. METHODS: The eight partner UME-21 schools exposed third- and fourth-year medical students to a variety of clinical experiences outside the traditional teaching hospital in such settings as physician offices, skilled nursing facilities, the patient's home, hospice, and public health departments. They also taught systems-based care skills such as care coordination, performance assessment, and quality improvement. RESULTS: Based on surveys of graduating students, the UME-21 programs were successful in exposing students to the aforementioned topics, though there was variability among schools. DISCUSSION: The experiences of the UME-21 schools in teaching about systems-based care, as discussed in this paper, may be useful to those involved in medical school curricula planning.

Clinical Clerkship↗

PubMed1994

The patient-centred case presentation.

The presentation of case histories is an important part of medical education, socialization and research. The traditional format of presentation, developed at the beginning of the century and based on disease-centred nosologies, has been criticized as minimizing the patient's story and subjective experience. It results in a separation of biological processes from the person. With the development of a patient-centred clinical method, it is desirable to have a patient-centred case presentation format that places the patient's subjective experience in the forefront, without sacrificing traditional biomedical aspects. This paper describes such a method and presents an example. This method is especially useful in the education of senior residents in family medicine, as it can serve to reinforce an attitude of 'patient-centredness'. The method can also serve as a useful bridge between the passive learning inherent in much of the education in medical schools and the active, adult learning necessary for graduate practitioners. By placing an emphasis on the person's subjective experience of illness, rather than solely on the disease, this way of presenting a case history readily suggests new questions and directions in research. The presentation of case histories is an underrecognized tool in family medicine. Changing the format of such presentations to be more consistent with the family medicine world view has implications for education and research.

Adult↗

PubMed2006

Patient involvement in setting research agendas.

Patient groups already support funding of trials and patient recruitment for colitis research. Patient and public engagement in setting research agendas for health research more generally is growing, particularly about the effects of treatment. Patient priorities for colitis research span a wide range of interests. Opportunities exist to build on strategic alliances between patient groups, clinicians and researchers for more open debate about what research should be done and how. Traditionally, patients and their families have two roles in health research: as research subjects, providing data at the request of researchers, and as fundraisers, supporting research and researchers. These roles are readily apparent in the area of research into inflammatory bowel disease, including colitis, and Crohn's disease, on both sides of the Atlantic. Growing evidence, however, suggests that health research agendas do not always reflect patients' priorities. Welfare et al. (this issue) add to the evidence by eliciting patients' priorities for colitis research. Methods for bridging patients' views and research agendas range from social science to deliberative public debate. In the first of these, social researchers, such as Welfare et al. (this issue), elicit and interpret patients' views and compare these with current research agendas. In the second, patients are supported and encouraged to engage in debates about research, whereby they bring their own interpretations and influence to the health research community. Organized colitis patient groups, with their current interests and alliances with research, are well placed to build on the work of Welfare et al., in partnership with researchers with the aim of planning research that meets the full range of their needs.

Colitis, Ulcerative↗

PubMed2003

Social capital and the built environment: the importance of walkable neighborhoods.

OBJECTIVES: I sought to examine whether pedestrian-oriented, mixed-use neighborhoods encourage enhanced levels of social and community engagement (i.e., social capital). METHODS: The study investigated the relationship between neighborhood design and individual levels of social capital. Data were obtained from a household survey that measured the social capital of citizens living in neighborhoods that ranged from traditional, mixed-use, pedestrian-oriented designs to modern, car-dependent suburban subdivisions in Galway, Ireland. RESULTS: The analyses indicate that persons living in walkable, mixed-use neighborhoods have higher levels of social capital compared with those living in car-oriented suburbs. Respondents living in walkable neighborhoods were more likely to know their neighbors, participate politically, trust others, and be socially engaged. CONCLUSIONS: Walkable, mixed-use neighborhood designs can encourage the development of social capital.

Automobile Driving↗

PubMed1989

School failure.

Numerous factors may contribute to a child's failure to learn. Certain causes of school failure, such as specific learning disabilities, mental retardation, sensory impairment, and chronic illness may be regarded as intrinsic characteristics of the child. Other causes, such as family dysfunction, social problems, and ineffective schooling, are characteristics of the child's environment. Still other influences on school performance, such as temperamental dysfunction, attention deficits, and emotional illness, may be viewed as the consequence of the interaction between the child and his or her environment. The reasons for a child's school failure must not be considered in isolation but rather within the context of social and environmental circumstances. Evaluation must consider the myriad of reasons for a child's school failure and attempt to identify "clusters" of adverse influences on school performance. Detailed information must be sought from the student, parents, and school system through the history and physical examination. Questionnaires are useful in data gathering. Ancillary methods of assessment that may be of value include neurodevelopmental screening and laboratory studies. Further investigations and referrals, particularly psychoeducational evaluation, are of major importance. Traditional roles of the pediatrician in school failure include the treatment of underlying medical conditions, counseling, the coordination of further investigations and referrals, and the facilitation of communication with community services and resources. Participation with other disciplines in the development of a child's educational plan is feasible and useful.

Achievement↗

PubMed1983

Mental health in the Third World.

In spite of great national and international efforts and relative success in achieving technological and economic progress, the underlying situation in the Third World offers little cause for optimism. Some notable exceptions notwithstanding, in most countries poverty is increasing at an alarming rate, with its accompanying misery, poor health, and social unrest. Unequal distribution of material wealth, political instability, and the crumbling of traditional and cultural values are also increasingly prevalent. Critical assessment of the philosophy, goals, and methodology of development is an urgent requirement in many nations. Mental health endeavors in the Third World need similar reformulation of both immediate and long range objectives and methods, if ever-increasing mental health demands fostered by such rapid and sweeping changes are to be met. Four major models--the hospital-based model, the medical school-based model, the community-based model, and the voluntary organization model--have so far been the basis for mental health development in Third World nations and, to a certain extent, have produced the needed personnel and services. A fifth model--the primary health care model--seems to hold more promise for the future. By virtue of its integration with general health and other administrative social networks, it can more easily reach out to the community, providing both curative and preventive mental health. Whichever model or combination of models any one nation or region adopts, future mental health endeavors in the Third World should be an integral part of overall social policy and health planning. Taking children, family, and school as major foci, such efforts are indispensible and should constitute a positive force in shaping the continuing process of social evolution.

Community Mental Health Services↗

PubMed1997

A baseline study of tobacco use among the staff of Aligarh Muslim University, Aligarh, India.

A cross-sectional study of 2,439 university employees and research scholars was carried out using the questionnaire method. The objective was to assess the prevalence and type of tobacco usage and to collect background data for planning health education programmes. The overall prevalence of tobacco usage was 51.5% among males and 30.3% among females. There were no female smokers, the preferred habit of tobacco usage among women being chewing. The prevalence of smoking among non-teaching staff members was significantly higher. Among females, the prevalence of tobacco chewers was higher in non-teaching staff members. Tobacco usage (both smoking and usage of other forms) rose with age. However, even at 20-30 years of age 25.4% of males were addicted to smoking. A majority of 60.6% had smoked for more than 10 years. Among the staff members (both teaching and non-teaching) the reason for smoking was either to relax or because of addiction, whereas the research scholars smoked to improve their image or for enjoyment/pleasure. The reasons given by users of other forms of tobacco were boredom, to pass the time or for no reason at all. Among non-users, the majority were aware of the harmful effects of smoking. Family pressure and traditions were also important reasons for not smoking. The study provides a clear picture of tobacco usage within the University.

Adult↗

PubMedDate not supplied

Publicity and the public health: the elimination of IUD-related abortion deaths.

Widespread publicity in the mass media about the dangers of leaving an IUD in place in a pregnant uterus was apparently more effective than traditional scientific publication and drug package inserts in getting doctors to remove devices from pregnant patients. This suggests that such publicity could be effective in improving clinical practice and the public health in other instances, such as getting doctors to prescribe and women to request birth control pills with lower doses of estrogen, and persuading women to obtain early rather than the riskier midtrimester abortions.

Abortion, Septic↗

PubMed1991

Comparison of immunofluorescence and culture for the detection of Actinomyces israelii in wearers of intra-uterine contraceptive devices.

A direct immunofluorescence (IF) method was compared with traditional culture methods for the detection of Actinomyces israelii in endocervical and intra-uterine-device (IUD) smears from 124 IUD wearers. Of 11 specimens that gave positive results by IF, only one was positive by culture. Of the 10 patients with positive IF specimens, three (30%) had signs and symptoms suggestive of pelvic infection and no other pathogen was detected. Direct IF of cervical smears offers a simple, relatively cheap method to screen IUD wearers for A. israelii. Clinical management of such cases is discussed.

Actinomyces↗

PubMed1994

Ethnic differentials in child-spacing ideals and practices in Ghana.

Postpartum sexual abstinence may be a major determinant of fertility and of maternal and child health in sub-Saharan Africa. This study examines the relationship between ethnicity and abstinence using data from the 1988 Ghana Demographic and Health Survey. There is considerable diversity in the length of abstinence although only for one ethnic group, the Mole-Dagbani and other Ghanaians, is abstinence, both actual and ideal, very long. Respondents in most ethnic groups believe their abstinence to be adequate. A key motivation for abstinence is the unwillingness to have sexual intercourse with nursing mothers. Education, urbanisation, changes in marriage patterns and religious traditions are major factors shaping the ethnic differentials in abstinence. In comparison to breast-feeding, abstinence appears to have relatively little impact on the length of the birth interval and for Ghana, has relatively few implications for fertility and child health.

Adolescent↗

PubMed1993

Moral reasoning and political conflict: the abortion controversy.

We argue that the abortion controversy has one major source--religion--and two less important ones--attitudes towards sexual permissiveness and women's employment. Traditional Christianity promotes opposition to abortion using three distinct modes of moral reasoning: through deductive moral reasoning, by the Christian world view's implication that abortion violates the sanctity of life and is a rebellion against God's design; through authoritative moral reasoning by appeal to Catholic dogma; and through consequentialist moral reasoning, as a means of control over sexuality and as a means of confining women's activities to the home. Even aside from Christian belief, adherence to traditional morality promotes opposition to abortion on these consequentialist grounds. We posit a model in which religious belief, anti-feminism, sexual permissiveness, and attitudes towards abortion are distinct concepts (a four-factor model) rather than all simply aspects of a single conservatism factor. We develop reliable, multiple item attitude scales; show that our four-factor model fits the data much better than the one-factor alternative; and test our hypotheses on new data from a large, representative national sample of Australia (N = 4540). Using maximum likelihood structural equation methods, we find that deductive reasoning from Christian belief is the most important source of opposition to abortion, with strong effects both direct and indirect. Exposure to the authority of the Catholic hierarchy is a real but weaker source of opposition. Consequentialist reasoning from traditional moral views on sex--partly buttressed by religion, partly independent of it--is also influential. But views on women's employment matter only a little, contrary to received wisdom.

Abortion, Legal↗

PubMed2001

Perception of stigma among family members of individuals with schizophrenia and major affective disorders in rural Ethiopia.

BACKGROUND: Many studies from the Western world have reported on stigmatisation of people with mental illnesses and its negative consequences, but few studies have addressed the issue in traditional rural societies. The present study aimed to estimate the extent and socio-demographic distribution of stigma as perceived by relatives of mentally ill individuals in rural Ethiopia. METHOD: A total of 178 relatives of individuals who were diagnosed as suffering from schizophrenia or major affective disorders in a community-based survey were interviewed using the Family Interview Schedule. RESULTS: About 75% of the respondents perceived that they were stigmatised or had experienced some sort of stigma due to the presence of mental illness in the family, 42% were worried about being treated differently and 37% wanted to conceal the fact that a relative was ill. Those from the older age group (45+) and urban residents were more likely to perceive stigma as a major problem, but otherwise differences were few between socio-demographic groups. The illness was attributed to supernatural forces by 27% and praying was suggested as a preferred method to deal with the problem by 65%. CONCLUSION: Stigma was found to be a common problem, with few differences between socio-demographic groups or between types of mental disorder. Beliefs about causes differ from those held by professionals. Popular beliefs and attitudes must be taken into account when planning for intervention.

Adult↗

PubMed1998

[A revolutionary Japanese method for treatment of lymphangioma].

Large cystic lymphangiomas of the neck (hygroma colli) have traditionally been treated surgically or by local injection of various sclerosing agents. Owing to the infiltrative growth of these cysts, radical surgery has often been difficult due to the risk of damage to nerves and adjacent organs; and the use of available sclerosing agents has often resulted in disfigurement due to extensive scarring, thus rendering secondary surgery even more difficult. However, OK-432, a new agent for local injection, has been tested with good results, especially in Japan. In five consecutive paediatric cases of lymphangioma, we found ultrasound-guided injection of the cysts with OK-432 to yield good response without complications. In three cases, the lymphangioma disappeared leaving the child's appearance quite normal, and there has been no recurrence. In one case, the lymphangioma disappeared but apparently recurred within half a year (during which time we had lost contact with the family). This was the only case of small cysts (cavernous lymphangioma), which are putatively more resistant to OK-432. The only child to be operated also had thoracic lymphangioma which was not injected, though the cervical part which was injected was reduced by 50 per cent pre-operatively, the final outcome being excellent with no visible cysts in any region. Thus, hitherto our results suggest the therapeutic effect of OK-432 to be good, and further clinical investigation is planned.

Antineoplastic Agents↗

PubMed2004

Gender issues in contraceptive use among educated women in Edo state, Nigeria.

BACKGROUND: While traditional contraception is widely used, in southern Nigerian modern contraception is a relatively recent phenomenon. Modern contraception is more wide spread among the educated and sexually active youth in Nigeria. Few studies have been done on contraception among educated women in Nigeria. OBJECTIVES: This study was carried out in December 2000 to determine factors that influence the choice of contraceptives among female undergraduates at the University of Benin and Edo State University Ekpoma. METHODS: Data was collected from a sample of 800 female undergraduates matched ethnic group, socio economic status, religion and rural urban residence. Subjects were selected by proportional representation and the instrument used was closed ended questionnaire. RESULTS: The responses obtained were analysed using Spearman Rank Correlation co-efficient and regression analysis. Findings revealed the highest correlation for availability (r =.96) vis a vis the use of various types of artificial contraceptive and cost (r =.96), next was safety (r =.95) and effectiveness (r =.95). Others were peer group influence (r =.80) and convenience (r =.77). CONCLUSION: An important step in improving women's reproductive health is the involvement of men. Health programmes should conduct campaigns to educate men about reproductive health and the role they can assume in family planning.

Adult↗

PubMed1995

Significance of beliefs and values in predicting fertility and contraceptive behaviour in Pakistan.

A comparative study of 1100 women aged 25-45 years, users and non-users of modern methods of contraception, in the urban centres of Lahore and Faisalabad was conducted in 1991. The objective of the study was to investigate reproductive behaviour and the extent to which social, cultural and attitudinal variables, such as beliefs and values about family life, religiosity and fatalism, influence the fertility decision-making process. Preferences for smaller families were found to be consistently associated with modern attitudes and behaviour towards family and religious values and obligations. Family income, husband's occupation and religiosity offered no explanation of reproductive behaviour. It is concluded that cultural setting and tradition exert an important influence on reproductive behaviour, independent of economic development.

Adult↗