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PubMed1998

[Dementias: impact on the family and prevention of caregivers' syndrome].

This article deals with the impact dementia can cause in a family in our modern society, an impact which often leads to a crisis or a rupture in a family. Due to the evolution in family structure in Spain over the last few decades, as evidenced by separations, divorces, reconstructed families, a descent in birth rate, and especially by women joining the work force, the possibilities for traditional family care of the elderly have become complicated and have been reduced, which leads to a tremendous physical and psychological wear on the person who takes on the largest part of this care, the so-called main caretaker, usually a woman. In consequence to this situation, dysfunctional behaviors may develop in this caretaker which, if not treated, may early or later on develop into the caretaker syndrome. The effects of this syndrome include subjective ones such as emotional suffering and objective ones such as a loss of health. This article presents a proposal for action by nurses acting out of primary health care centers which leads to a series of measures providing containing methods and formal support structures, in other words prevention, for the family and especially for the main caretaker of patients suffering from dementia.

Caregivers↗
PubMed1990

Culture: the impact on health care.

Cultural and ethnic issues are not examined in traditional health care professional education. Our experience in providing care for terminally ill cancer patients in their homes in a multicultural metropolitan area has demonstrated repeatedly the importance of these issues. They can help us to understand how illness is perceived, who provides care, how it is provided, and how health care professionals are accepted. In order to sensitize health professionals to important health/cultural values, a multicultural resource center in our city invites lecturers to speak on health related issues, ranging from nutritional attitudes to religious taboos. Workshops geared toward specific disciplines are available at another resource center. Inservice education on palliative care, offered one hour a week, is one method of highlighting cultural issues for the staff. General nursing rounds, presented once a month for the hospital, is another, as is the hospital nursing journal, which has a column for multicultural contributions. A complete cultural assessment is anthropologically oriented, but a shortened version, dealing with the family hierarchy of power, a cultural/medical assessment, and an awareness of general behavioural differences can help bridge the cultural gap. This paper will present a practical model of cultural assessment that can be used by health professionals. It will suggest simple interventions that can be incorporated in a health care plan.

Curriculum↗
PubMed2001

Is fertility declining in Benin?

This study analyzes reproductive changes in Benin, a West African country with high fertility and low prevalence of use of modern contraceptive methods, using a combination of quantitative and qualitative approaches. Findings indicate that an irreversible fertility transition has started as the result of an emerging pattern of birth limitation and continued desire for the traditional long birth intervals. The data suggest that changes in childhood mortality in combination with an increase in women's education, although modest, have created a demand for fertility control among women; that induced abortion may be one of the means through which such demand is being met, particularly in urban areas; and that the economic crisis of the 1980s was the main catalyst that precipitated the onset of transition. Changes in reproductive preferences and practice suggest a diffusion process, from urban and more educated women to rural and less-educated ones.

Adolescent↗
PubMed2006

Maternal health-seeking behavior and associated factors in a rural Nigerian community.

OBJECTIVES: To assess maternal health services and health-seeking behavior in a rural community (Ologbo), located in the South-south zone of Nigeria. METHODS: Structured questionnaire was administered to 225 randomly selected mothers (age 15-49 years), and was analyzed using SPSS. Six focus group discussion sessions were also conducted-four for community women and two for health workers. RESULTS: Teenagers constituted 13.3% of the respondents. The average number of children per woman ranged from 2.5 for teenagers to 9.0 for women aged 45-49 years. Eighty percent of respondents knew at least one major medical cause of maternal mortality: the most common causes mentioned were hemorrhage (31.8%) and obstructed labor (17.3%). Private maternity center was the most preferred place for childbirth (37.3%), followed by traditional birth attendants (TBAs) (25.5%). Government facility was preferred by only 15.7%: reasons for the low preference included irregularity of staff at work (31.4%), poor quality of services (24.3%), and high costs (19.2%). Among the 81 women that delivered within a 1-year period, only 9.9% received antenatal care, 6.2% received two doses of tetanus toxoid, while 4.9% attended postnatal clinic. Private midwives and TBAs attended 49.4 and 42.0% of deliveries, respectively. Education was found to be significantly associated with choice of place for delivery (p < 0.05), but no association was found with respect to age and marital status. Only 11.4% of mothers were practicing family planning. CONCLUSIONS: Poor health-seeking behavior is a challenge in rural Nigeria, and interventions are needed to achieve improved maternal health status.

Adolescent↗
PubMed2004

The importance of cultural factors in the planning of rehabilitation services in a remote area of Papua New Guinea.

PURPOSE: The aim of this study in the Middle Ramu, Papua New Guinea, was to gain a better understanding of how cultural factors work to influence the lives of persons with disability in a remote area. The study also explores how this information can be used for the planning of rehabilitation services. METHOD: Two phase screening identified persons with disability in the study area and questionnaires were completed for all those identified. Information documented included the nature of the disability, a biomedical cause (where appropriate), the perceived cause of the disability, as well as some indication as to where help had been sought for the disability. In depth interviews were later done with disabled individuals and their families, to determine how they explained their disability. RESULTS: Thirty-two per cent of persons with disability and their families attributed disability to sorcery or other supernatural causes, a greater proportion than for any other category of perceived aetiology. There was widespread acceptance of Western medicine, although help was more likely to be sought from sources in the community for disabilities believed to have a supernatural origin. CONCLUSIONS: This study demonstrates that an understanding of cultural factors is fundamental to implementing rehabilitation services that are culturally appropriate and address the social dimension of disability.

Culture↗
PubMed2002

[Obstetrics and gynecology--retrospect of 125 years in Basel].

The development of the discipline Obstetrics and Gynecology is reflected by the medical history at the University of Basel. At the very beginning of academic obstetrics, the cantonal government realised the need of a more practical teaching completing the tradition of theoretical lecturing (1865). Obstetrics was (and still is) a typical example for the turn from theoretical to hands-on-teaching in medicine. At the time, when the independent chair of obstetrics at the University of Basel was founded (1867, Bischoff [1841-1892]), the fight against puerperal fever was the most urgent aim. The battle against puerperal fever was ultimately won around the turn of the 19th to the 20th century (von Herff [1856-1916]) but not much earlier. Step by step the gynecology grew out of the classical surgery where it has been located previously. Surgically skilled obstetricians like Fehling [1847-1925] and Bumm [1868-1925] have enhanced that development. Clinical research started with better information about the lying-in patients (Fehling, Bumm, Labhardt). Bacteriology in close connection with obstetrics was seen important (Bumm). Some decades later, clinical laboratories (clinical chemistry) were founded accompanying the diagnostic approach to various disorders of pregnancy (Labhardt [1874-1949]). Exfoliative cytology became mandatory since 1950 and this was the start to screening programs for early diagnosis of cervical cancer (Koller [1899-1985]). The family planning exploded in the years from 1965 on as the pill has been available, replacing sterilisation-procedures (Labhardt). Endocrinology of pregnancy and cycle needed new biochemical methods. The laboratories were installed. Responding to the demands of a growing discipline, the building was enlarged and adapted in three major steps: 1896 new "Frauenspital", 1928 first enlargement, 1956-1968 constructing of two more storeys, of new surgical theatres and an entire tract for routine and scientific laboratories filling now the area between Klingelberg-, Schanzen- and Spitalstrasse. The hospital harboured in its peak time (1968-1970) more than 300 beds. In 1959 the hospital staff took care of 5000 deliveries (Koller). Fetal monitoring was introduced 1962, being the starting point for the development of "fetal medicine" in Basel. At that time, Otto Käser [1899-1995] was chairman. He was appreciated as one of the most brilliant pelvic surgeons in Europe. Soon, the surgery for breast cancer was added to the classical gynecologic surgery. At the same time, ultrasound started to dramatically influence diagnostic procedures in pregnancy. In the eighties, in-vitro-fertilization and embryo-transfer improved the possibilities to overcome unwanted childlessness (Ludwig [*1929]) and supplemented endocrinology. The scientific spectre spread heavily to reproductive medicine since then, in particular to the molecular biology and research on stem-cells, which was introduced by the present chairman (Holzgreve [*1955]). He has founded several research groups concentrating on the retrieval of floating fetal cells from cord and maternal blood, on other topics in fetal cell research, prenatal diagnosis and in ultrasound.

Female↗
PubMed1986

A developmental approach to pregnancy prevention with early adolescent females.

Traditional pregnancy prevention strategies employed with adults and older teens do not recognize significant developmental differences between early adolescents and other age groups. Methods that compliment, reflect, and are consistent with developmental needs of the young teen provide cogent approaches to teen pregnancy prevention. Particular emphasis should be placed on interpersonal relationships and their importance in the young woman's life, especially the relationship between the young teen and her parents. Developing and improving all relationships instrumental in positively affecting teen decision-making represent potent approaches to pregnancy prevention. The axioms of Piaget, Erikson, and Mercer are examined in regard to cognitive, social, emotional, and psychosexual development in the 12-14 year old. Young teens' responses to sex education as well as their use of contraception are reviewed in relation to developmental theory.

Adolescent↗
PubMed1994

Laparoscopic Pomeroy tubal ligation as a teaching model for residents.

We reviewed our preliminary experience with laparoscopically directed bilateral midtubal resection for tubal ligation (endoscopic Pomeroy) as a potential teaching tool for the acquisition of endoscopic skills during residency training. Thirty-five laparoscopic Pomeroy and 206 banding procedures were reviewed. Age, parity and weight were similar in the two groups. The operative time for banding was reduced slightly after experience with > 10 procedures. In contrast, the operative time for laparoscopic Pomeroy procedures decreased dramatically after individual experience with only a few (< or = 5) procedures. The mean operative time for the Pomeroy group approached that of the more traditional banding technique at five procedures. Our data indicate that laparoscopic Pomeroy sterilization can be an effective teaching tool for operative laparoscopy, allowing residents to repeatedly perform an easy and safe procedure that incorporates basic techniques. Advanced operative endoscopic procedures could then be taught more efficiently after the acquisition of basic skills.

Adult↗
PubMed2006

Efficacy and effectiveness of community-based treatment of severe malnutrition.

BACKGROUND: There is a long tradition of community-based rehabilitation for treatment of severe malnutrition: the question is whether it is effective and whether it should be advised for routine health systems. OBJECTIVE: To examine the effectiveness of rehabilitating severely malnourished children in the community in nonemergency situations. METHODS: A literature search was conducted of community-based rehabilitation programs delivered by day-care nutrition centers, residential nutrition centers, primary health clinics, and domiciliary care with or without provision of food, for the period 1980-2005. Effectiveness was defined as mortality of less than 5% and an average weight gain of at least 5 g/kg/day. RESULTS: Thirty-three studies of community-based rehabilitation were examined and summarized. Eleven (33%) programs were considered effective. Of the sub-sample of programs reported since 1995, 8 of 13 (62%) were effective. None of the programs operating within routine health systems without external assistance was effective. CONCLUSIONS: With careful planning and resources, all four delivery systems can be effective. It is unlikely that a single delivery system would suit all situations worldwide. The choice of a system depends on local factors. High energy intakes (> 150 kcal/kg/day), high protein intakes (4-6 g/kg/day), and provision of micronutrients are essential for success. When done well, rehabilitation at home with family foods is more cost-effective than inpatient care, but the cost effectiveness of ready-to-use therapeutic foods (RUTF) versus family foods has not been studied. Where children have access to a functioning primary health-care system and can be monitored, the rehabilitation phase of treatment of severe malnutrition should take place in the community rather than in the hospital but only if caregivers can make energy- and protein-dense food mixtures or are given RUTF. For routine health services, the cost of RUTF, logistics of procurement and distribution, and sustainability need to be carefully considered.

Child Health Services↗
PubMed2006

Placement disruption and negative placement outcomes among adolescents in long-term foster care: the role of behavior problems.

OBJECTIVE: This study examined risk of placement disruption and negative placement outcomes (e.g., residential treatment and incarceration) among adolescents placed in traditional family foster care for a year or longer. A foster parent's report of externalizing behavior problems was expected to be a stronger predictor of disruption and negative outcomes than a caseworker's report. Additionally, the association between behavior problems and placement disruption was expected to be mediated by the youth's degree of belonging and integration in the foster home. METHOD: The caseworkers and foster parents of 179 randomly selected 12-13-year-old adolescents placed in traditional foster care were interviewed by telephone. Interviews included standardized measures of externalizing behavioral problems and several other variables that have been previously associated with placement movement. Disruption from the youth's foster home at the time of the interview was prospectively tracked for 5 years. RESULTS: Over half of the youth experienced a disruption of their placement. Contrary to expectations, behavior problems as reported by caseworkers, but not foster parents, were predictive of placement disruption. However, the foster parent's report of behavior problems predicted risk of negative outcome after a period of 5 years. As hypothesized, integration in the foster home was highly predictive of placement stability and mediated the association between behavior problems and risk of disruption. CONCLUSIONS: Results suggest that integration in the foster home might be an important dimension of placement adaptation that should be considered during service planning for foster youth in long-term foster care. In addition, using standardized measures of behavior with both foster parents and caseworkers might be necessary to assess both long-term risk of negative outcomes and more immediate risk of placement disruption.

Adolescent↗
PubMed1996

Lactation, nutrition, and postpartum amenorrhea in lowland Papua New Guinea.

Prolonged on-demand breast feeding is known to delay the resumption of postpartum ovarian cyclicity. At present, however, little is known about the factors that influence the effectiveness of breast feeding as a natural contraceptive. Here, I examine the effects of maternal nutritional status on the duration of postpartum amenorrhea in two socioeconomic groups of Au forager-horticulturalists of lowland Papua New Guinea. Although women in both groups continue to breast-feed their offspring for approximately three and one-half years, well-nourished wage-earning Au women experience their first postpartum menses just over one year earlier (median = 12.5 months) than their more poorly nourished traditional counterparts (median = 26.6 months). Probit analyses are used to demonstrate that, even after controlling for time since delivery, maternal age, parity, and supplementation of infants' diets, the duration of postpartum amenorrhea is significantly (p < 0.05) negatively associated with indexes of maternal fat mass. No association between indexes of maternal lean body mass and the duration of postpartum amenorrhea were found. The results of this study suggest that components of maternal nutritional status, in particular, adiposity, play an important role in influencing fecundity in human populations.

Amenorrhea↗
PubMedDate not supplied

Use of contraceptives for birth spacing in a Nigerian city.

This paper examines the use of contraceptives among women aged 15-35 in the urban area of Ilorin, Nigeria, with particular focus on use for the purpose of spacing births. Approximately 19 percent of ever-married women in the sample had used contraceptives at some time and approximately 6 percent were using at the time of the survey. Results suggest that some women have used or are using contraceptives as a substitute for prolonged periods of postpartum sexual abstinence. Whereas all groups of women in the study prefer to maintain an interval of two years between births, less traditional women no longer prefer to observe long periods of postpartum sexual abstinence. For some women, therefore, there is a wide gap between the length of preferred birth interval and the length of preferred abstinence. The magnitude of this gap is significantly associated with both ever use and current use of contraceptives. Other variables found to have a significant independent effect on contraceptive use were total number of children desired, maternal age, and maternal education.

Adolescent↗
PubMed2006

Contraceptive awareness among men in Bangladesh.

OBJECTIVE: A considerable gap exists between contraceptive awareness and use. Traditional approaches to measuring awareness are inadequate to properly understand the linkages between awareness and use. The objective of this study was to examine the degree of men's modern contraceptive awareness in Bangladesh and the associated determinants and further testing of a hypothesis that current contraceptive use confers a high degree of method awareness. METHODS: This study used the couple data set from the Bangladesh Demographic and Health Survey (1999-2000). A two-level, multinomial logistic regression was used with the degree of contraceptive awareness as the dependent variable. The degree of awareness was measured by the reported number of modern contraceptive methods known among men aged 15-59 years. Men's responses on method awareness were classified according to those reported spontaneously and probed. RESULTS: Nearly 100% of the study participants reported having heard of at least one method and about half reported awareness of at least eight different methods of contraception. Multinomial logistic regression analyses showed that older and educated men were more likely to have reported a high degree of awareness. The findings confirmed our hypothesis that current contraceptive use is likely to confer a high degree of modern method awareness among men (p<0.001), after controlling for other important characteristics. CONCLUSIONS: Men who had a low degree of contraceptive awareness seem not properly informed of the wide range of contraceptive options. It is imperative that family planning intervention strategies in Bangladesh should focus on the degree and functional knowledge of contraceptive methods to improve the uptake of especially male-based modern methods.

Adolescent↗
PubMed2000

Physician satisfaction with Medicaid managed care: the Missouri experience.

BACKGROUND: Medicaid managed care is important to health reform at the state level. However, little is known about physician satisfaction with these programs. We sought to measure this satisfaction in Missouri and determine its predictors. METHODS: We surveyed a random sample of primary care physicians participating in Medicaid managed care (n = 670) or traditional Medicaid (n = 670). Primary outcomes measured were physicians' satisfaction Medicaid managed care, traditional Medicaid and commercial managed care. Satisfaction was measured on a 5-point Likert-type scale. RESULTS: The response rate was 52%. Physicians participating in Medicaid managed care were less likely to be satisfied or very satisfied with Medicaid managed care (28.6%) than with commercial managed care (40%) or their previous experience with traditional Medicaid (39.7%). Among physicians participating in traditional Medicaid, 29.8% were satisfied or very satisfied with traditional Medicaid. Physicians participating in Medicaid managed care were less satisfied with clinical autonomy under that system in comparison with their previous experience with traditional Medicaid (relative difference = 10.8%, P =.001). In multiple linear regression analyses, clinical autonomy (R2 = 0.40) was a strong predictor of overall satisfaction with Medicaid managed care. CONCLUSIONS: Enhancing physicians' clinical autonomy may result in improved satisfaction with Medicaid managed care. State Medicaid agencies should include physician satisfaction as a measure of Medicaid managed care plans' quality.

Attitude of Health Personnel↗
PubMed1993

Influence of son preference on the contraceptive use and fertility of Sri Lankan women.

The effect of moderate son preference on family size is analysed using data from the 1982 Sri Lanka Contraceptive Prevalence Survey whose respondents were followed-up in the 1985 Sri Lanka Contraceptive Survey. Reported reproductive intentions on desire for additional children were not always reflected in overall contraceptive use. Complicating factors were the use of modern and traditional methods and the role of induced abortion. Longitudinal observations of the 1982-85 period relating women's individual reproductive behaviour to their intentions show no consistent behavioural difference between those with and without sons. However, at any given parity, the proportion reporting at least one additional child born during the intersurvey period was higher among those women who intended to have at least one additional child than among those who wanted to stop childbearing. This analysis suggests that son preference finds expression more through reproductive intentions than through actual fertility behaviour in the follow-up period.

Adolescent↗
PubMedDate not supplied

The computer in general practice.

Interest in computers is becoming commonplace in general practice. Many practices in the UK have already installed complete systems, others are in the processes of developing them. Most general practitioners will buy complete systems off-the-shelf, but a small minority will do their own systems design and programming. The computer, as part of an information system for general practice, will go through three phases: the cross-indexing system, the narrative record, and the decision aid. All systems currently installed are at the level of the cross-indexing system. This retains the traditional clinical record as the main repository of information stored in hard copy, but provides convenient and entropy proof methods of identifying cohorts of patients by such characteristics as age, sex, social class, geographical distribution, or disease entity. The purposes for this will be preventive medicine, quality control, administrative planning, educational planning, and possibly research. These functions replace manual systems which have been in use by a small number of general practitioners for twenty years, but which have never gained general acceptance partly because of their clumsiness and partly because they were seen as research tools. The step to the narrative record will not be worth the investment in resource or energy if it is purely to store the current undisciplined paper record in electronic medium. It will only be worthwhile if two preconditions are met: firstly, that some standardized form of recording such as problem-orientated medical records are accepted and, secondly, if it is accepted by the doctor that he is handing over a certain amount of control to the system which will prompt, cue and remind him of things that have to be done.(ABSTRACT TRUNCATED AT 250 WORDS)

Computers↗
PubMed1997

Women's hidden transcripts about abortion in Brazil.

Two folk medical conditions, "delayed" (atrasada) and "suspended" (suspendida) menstruation, are described as perceived by poor Brazilian women in Northeast Brazil. Culturally prescribed methods to "regulate" these conditions and provoke menstrual bleeding are also described, including ingesting herbal remedies, patent drugs, and modern pharmaceuticals. The ingestion of such self-administered remedies is facilitated by the cognitive ambiguity, euphemisms, folklore, etc., which surround conception and gestation. The authors argue that the ethnomedical conditions of "delayed" and "suspended" menstruation and subsequent menstrual regulation are part of the "hidden reproductive transcript" of poor and powerless Brazilian women. Through popular culture, they voice their collective dissent to the official, public opinion about the illegality and immorality of induced abortion and the chronic lack of family planning services in Northeast Brazil. While many health professionals consider women's explanations of menstrual regulation as a "cover-up" for self-induced abortions, such popular justifications may represent either an unconscious or artful manipulation of hegemonic, anti-abortion ideology expressed in prudent, unobtrusive and veiled ways. The development of safer abortion alternatives should consider women's hidden reproductive transcripts.

Abortion, Illegal↗
PubMed1992

The induction of amenorrhoea.

A survey has shown that many women favour eliminating menstruation and it has been suggested that therapeutic induction of amenorrhoea might be an advantage in female personnel mobilised for war. The traditional method has been to take the oral contraceptive pill continuously. This produces weight gain and other side-effects; spotting and breakthrough bleeding can be a problem initially. The method is however cheap. The Gonadotrophin Releasing Hormone (GnRH) analogue, goserelin, is extremely effective, produces less side-effects, but it is very expensive. Two synthetic steroids, danazol and gestrinone, are moderately effective, have a variety of prominent side-effects and are also quite expensive. With all these drugs normal menstruation resumes in the cycle after they are discontinued. Although goserelin has many advantages over the continuously taken contraceptive pill, its cost precludes it from consideration as a means of eliminating menstruation.

Amenorrhea↗