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PubMedDate not supplied

A profile of menstrual disorders in a private set up.

Menstruation and its disorders are still considered unholy and impure and are not yet recognised as significant reproductive health morbidity. Therefore a prospective study was carried out at a private clinic for a period of three months where total number of patients coming with current or past menstrual problems are 525. This number did not include pregnant women or those on any hormonal medications or having dysfunctional uterine bleeding. This study aimed to find out the incidence of Menstrual Morbidity and their mode of presentation. It has also tried to find out these women's age, parity, age of menarche and number, following discriminating traditional rituals during their 1st and regular menses, their family planning status and the districts from where they came to Kathmandu for their treatment. In this study, menstrual morbidity was found to be 43.75%. Approximately 60% of women having menstrual complaints had absolutely normal menstrual cycle; whereas 13% of them had irregular, 17% of them had prolonged and 6% had short menstrual cycle. A significant number (46%) of women although suffering from menstrual problems presented with other symptoms like vaginal discharge, pain lower abdomen, subfertility, urinary problems, abdominal lumps and for cuT check-ups. 3% of the women who presented with vague, non-specific complaints asking for a general check up had one or the other menstrual problem. Although approximately 69% of these women were from the age group of 20-39 years, 4% of them were adolescents and 27% above 40 years. It was observed that although approximately 78% of these women were primi- and multiparous ladies, 22% were unmarried and nulliparous suffering from various menstrual morbidities. More than 55% of these women had their menarche at the age of 12-14 years. It was not surprising to note that more than 90% of women had to follow the traditional unhealthy and unsociable rituals during their first menstruation. More than 75% of them had to follow the discriminating traditional rituals which consider a menstruating woman untouchable for 5 days of every month throughout their active reproductive lives. 20% of these women were using non-hormonal contraceptive methods, out of which more than 50% had undergone permanent sterilisation. It was a matter of pride to note that this clinic was providing the health care services to the adolescents and women of 13 zones and more than 52 districts of the country.

Adolescent↗
PubMedDate not supplied

Human health concerns from pet ownership after a tornado.

INTRODUCTION: Although 50% to 60% of North American households own pets and many of these pets are considered family members, there is little information on the impact of pet ownership on pet-owning families affected by disasters. METHODS: This case report describes some of the effects of a tornado on 17 families whose dwellings were destroyed. The setting was a typical urban trailer park. RESULTS: After a tornado at the Sagamore Village Trailer Park in north central Indiana, 104 families were evacuated. Seventeen (16.3%) of these families owned pets. For 14 families (13.5%), pet ownership had an important impact on the families' recovery from the tornado. Public- and mental-health concerns that arose from pet ownership included failure to evacuate a dangerous site, attempts to re-enter a dangerous site, separation anxiety leading to psychosomatic disturbances, and the need for additional animal care. CONCLUSIONS: In urban disasters, the behaviors of families with a human-animal bond are likely to pose a significant risk to their own and others' health and safety in urban disasters. In this small study of families affected by a tornado, the most prominent public-health concerns were failure to evacuate because of a pet and attempts of re-entry to save a pet; the most common mental-health concerns resulted from separation anxiety from a pet and refusal to accept medical treatment until a pet's well-being can be assured. These are thought to be typical issues that will arise out of the human-animal bond in urban disaster situations and differ considerably from traditional public-health concerns over dog bites, spread of zoonotic diseases, and human food contamination. Medical disaster preparedness planning should consider the substantial effects that the human-animal bond is likely to have on human recovery from large-scale urban disasters.

Adult↗
PubMed1992

An experiential program to reduce AIDS risk among female sex partners of injection-drug users.

This article describes the development and implementation of an acquired immune deficiency syndrome (AIDS) intervention program for female sex partners of male injection-drug users. Four psychoeducational workshops were designed to motivate personal risk reduction, provide participants with necessary cognitive and behavioral skills, and enhance participants' perceived ability to enact positive changes in their lives. The development of the workshop modules was guided by traditional theories of health behavior change and social learning. Also included in the intervention are referral and advocacy services, personal risk reduction counseling, and human immunodeficiency virus (HIV) antibody testing. Preliminary results indicate that the program has made a significant impact on the AIDS risk of participants--91 percent of women who completed the program reported that they had made positive changes in their lives to reduce their risk of HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Mechanism of action of oral contraceptives on carbohydrate metabolism at the cellular level.

Although the available scientific data on the undesired metabolic effects of sex steroids have accumulated rapidly, most are of a descriptive nature, and only a few studies elucidate the impact at the cellular level and the possible interrelationship between different metabolic systems. This review summarizes the influence of different contraceptive steroid combinations on glucose metabolism and points to the possible mechanisms behind a disturbance of the euglycemic homeostasis with a concomitant change in lipid metabolism. Today the general concept is that the influence of combined sex steroid products on glucose metabolism is mainly caused by the progestogen components, although artificial estrogens may act synergistically. The diabetogenic effects of the progestogens make it important to consider the development during the last decade of the new more selective progestogens of the gonane type. From recent studies it seems, however, that intake of contraceptive combinations of ethinyl estradiol in combination with these types of gonanes, such as desogestrel and gestodene, may also be accompanied by increased insulin resistance, specifically, a hyperinsulinemic response to a glucose challenge despite unchanged glucose values compared with a baseline test. This is similar to observations made with combinations of ethinyl estradiol and other more traditional types of progestogens of the gonane and estrane type. It is conceivable that the diabetogenic effects of the progestogens are caused by a change in insulin receptor binding or a postreceptor defect in the cellular insulin action. The clinical implications of the diabetogenic effects of the sex steroids are hard to interpret, but more long-term exposure of arterial tissue to elevated concentrations of glucose and insulin results in inhibition of lipolysis and synthesis of cholesterol and triglycerides, which result in the development of lipid-filled lesions--fatty streaks--similar to those of early atherosclerosis.

Blood Glucose↗
PubMed1997

Ethical issues relating to reproduction control and women's health.

There are many ethical aspects which derive from the application of reproduction control in women's health. Women's health can be enhanced if women are given the opportunity to make their own reproduction choices about sex, contraception, abortion and application of reproductive technologies. The main issues that raise ethical dilemmas following the development of assisted reproduction techniques are: the right to procreate or reproduce; the process of in vitro fertilization itself-is it morally acceptable to interfere in the reproduction process?; the moral status of the embryo; the involvement of a third party in the reproductive process by genetic material donation; the practice of surrogacy, cryopreservation of pre-embryos; genetic manipulation; experiments on pre-embryos, etc. Induced abortion raises ethical issues related to the rights of the woman versus the rights of the fetus. For those who consider life to begin at conception abortion always equals murder and is therefore forbidden. Those who believe in the absolute autonomy of the woman over her body take the other extreme approach. The discussion surrounding abortion usually centers on whether it should be legal or illegal. Access to safe abortion is critical to the health of women and to their autonomy. The development of new effective contraceptive methods has a profound impact on women's lives. By the use of contraception it is possible to lessen maternal, infant and child mortality and to reduce the prevalence of sexually transmitted diseases. Research and development of new effective reversible contraceptives for women and men is needed. Dissemination of information about the safety and effectiveness of contraceptive methods is of great importance. Female genital mutilation is still practiced worldwide due to customs and tradition among various ethnic groups. The procedure is considered to be medically detrimental to the physical and mental health of women and girls, and is considered by many as oppression of women. The practice has to be stopped. Recognition of the fetus as a 'patient' has a potential effect on women's right for autonomy; they have no legal obligation to undergo invasive procedures and to risk their health for the sake of their fetuses. The woman carries ethical obligations toward her fetus. This obligation should not be enforced by the law. At present women bear most of the burden of reproductive health. All of them have a right of access to fertility regulation. Governments and society must ensure the women's equal rights to health care just as men have in the regulation of their fertility.

Abortion, Induced↗
PubMed1997

No-scalpel vasectomy: review of the first 1,000 cases in a family medicine unit.

In Mexico, the Mexican Institute of Social Security (IMSS) had adopted the no-scalpel vasectomy technique by the end of 1989. The technique was described by Dr. Li Shunquiang in 1974, and more than 60 million no-scalpel vasectomies have been performed in 26 countries. Among the advantages with no-scalpel vasectomy is that it has fewer complications (0.4%) compared to the traditional technique (3.1%). We studied 1,000 clinical charts of the subjects operated on between January, 1990 and January, 1993, with the objective of reporting our experiences as well as analyzing whether there existed a correlation between the subject's social and demographic characteristics and the number of control spermatic counts he attended postoperatively. In 97.9% of the cases, subjects had no postoperative hemorrhage or hematoma. None of the subjects had a surgical wound infection. In addition, 54.4% of the subjects came to the first control spermatic count, 39.7% came to the second, and only 18.4% came to all three controls. In an attempt to find a characteristic which defined the subject who attends his postoperative control spermatic counts, we found an association using chi2 between the attendance at two controls with the subjects who had been married from 6 - 10 years (p = 0.059), and with the subjects who had an income of three minimum wages. Regarding the attendance at all three controls, we found an association with subjects who had an income of two minimum wages (p = 0.037). We also found a weak correlation between the attendance at all three controls and the reason reported for not having more children (the couple did not want more children) (r = 0.07; p = 0.025) and with the manner in which the subjects were referred to the clinic (came on their own initiative) (r = 0.09; p = 0.006). Finally, we consider that no-scalpel vasectomy can be implemented as an adequate family planning method in Mexico's primary care centers. The lack of adequate attendance at postoperative control spermatic counts does not seem to have an important association with the subject's demographic characteristics, so it appears warranted that this issue be studied from a psychological point of view.

Adult↗
PubMed1991

Clinical experience with the recently developed progestogens.

The third generation of combination estrogen/progestogen oral contraceptives (OCs) first became available in the early 1980s. The gonanes (e.g., norgestimate, desogestrel, and gestodene) are alternatives to the long-standing progestogens, norethindrone and norgestrel/levonorgestrel. While the newer compounds are related to levonorgestrel, their biochemical structure differs. All, however, are strongly progestogenic with respect to ovulation inhibition and are very selective in their affinity for endometrial progesterone receptors. At present, experience with the third-generation combined OCs is relatively limited, and extensive comparative data have yet to be accrued. Nevertheless, these ultra-low-dose compounds appear to be as efficacious as the traditional OCs, while their cycle control may be slightly superior. In addition, the incidence of minor side effects, such as nausea, weight gain, and mastalgia, compares favorably with that of the earlier OCs. In combination with estrogen, these new progestogens have revealed a neutral or possibly beneficial effect on lipid/lipoprotein metabolism. Thus, the newer progestogens do not appear to have adverse effects on the cardiovascular system and offer a range of noncontraceptive health benefits.

Contraceptives, Oral, Combined↗
PubMed2004

Evaluation of the UME-21 initiative at 18 medical schools between 1999 and 2001.

BACKGROUND: This study evaluated the processes of curricular change and the initial outcomes of the Undergraduate Medical Education for the 21st Century (UME-21) project at 18 schools. METHODS: Site visits were conducted at eight partner schools in 1999 and 2001. Written proposals, progress reports, and final reports of 18 schools were reviewed. Senior medical students' responses to questionnaires, including the annual Association of American Medical Colleges Graduation Questionnaire and a UME-21 supplemental graduation questionnaire, were analyzed. RESULTS: There was variation among the schools in the curriculum at baseline, in the structure of the UME-21 innovation that was introduced, and in the process of implementation. There was an increase in seniors' ratings of instruction in the newer areas of evidencebased medicine, quality assurance, and cost-effectiveness in relation to national norms between 1999 and 2001. There was less impact on the more traditional content areas of ethics, patient communications, prevention, and leadership skills. CONCLUSIONS: The circumstances of the national evaluation introduced many methodological complexities, some of which could have been avoided if planning for evaluation had started earlier. However, the evaluation revealed that even modest funding directed toward specific curricular goals can produce measurable change and can have effects that extend beyond the initial scope of the project.

Clinical Clerkship↗
PubMedDate not supplied

Patterns of condom use and sexual behavior among never-married women.

BACKGROUND AND OBJECTIVES: Use of condoms is one of the main methods sexually active persons may choose to prevent infection with sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). Little is known about patterns of condom use among women in the United States. We provide a conceptualization of patterns of condom use and factors associated with these patterns. GOAL OF THIS STUDY: To examine patterns of condom use and associated characteristics among sexually active, never-married women in the United States. STUDY DESIGN: Analysis of data from the 1988 National Survey of Family Growth, which is a nationally representative sample of women in their childbearing years. RESULTS: Only a minority of sexually active, never-married women report using condoms, and even fewer report using them consistently. Women with characteristics traditionally associated with increased risk of infection with STD and HIV appear to be less likely to report using condoms and to report using them consistently. Women who report use of condoms to prevent STDs are more likely to report consistent condom use; less likely to cease using condoms; and more likely to initiate consistent condom use. CONCLUSION: Findings suggest the need for innovative programming targeted for specific sexually active populations to promote both initiation and maintenance of use of condoms.

Adolescent↗
PubMed1999

Precept-Assist. a computerized, data-based evaluation system.

BACKGROUND AND OBJECTIVES: Traditional methods of resident evaluation have several limitations, including recall bias and memory decay. We developed a real-time, computerized, data-based evaluation system and determined 1) the feasibility of using such a system in an ambulatory care teaching center and 2) the types of evaluation data such a computer-based evaluation system provides to residency directors, faculty, and residents. METHODS: We developed Precept-Assist, a computerized, data-based evaluation system. Reports from the system provide quantitative data, summative reports, and qualitative comments regarding specific competencies of residents. Following each precepting encounter between a faculty member and a resident, the faculty member entered into the system an array of coded information on the resident's level of performance, competencies achieved, and procedural skills. RESULTS: We have entered more than 15,000 pieces of evaluative data on 4,504 precepting encounters. The average time to enter data was about 40 seconds per encounter. Reports were generated to monitor each resident's progress through the program. The information was used to generate learning plans tailored to each resident's needs. CONCLUSIONS: Precept-Assist was useful for evaluating the performance of residents in this study.

Computers↗
PubMed2006

Traditional beliefs as forgotten influencing factors on breast-feeding performance in Turkey.

OBJECTIVE: The aim of this cross-sectional study was to identify the infant feeding practices and to evaluate the attitudes and beliefs of mothers on breast-feeding in Turkey. METHODS: This study was established in 10 provinces of Turkey between December 2000 and March 2001 and the study group was comprised of 1,767 women between the ages of 15-49 years (mean 27.6 +/- 6.4 years). Questionnaires were self-filled by mothers in the waiting rooms of the health centers. RESULTS: One hundred seventy-three women (9.9%) were illiterate, 829 (47.7%) had < or =5 years of schooling, and 83.4% were housewives. A significant number of women have traditional beliefs related to breast-feeding practices. According to 23.4% of the women at least 3 calls to prayer (average 12 hours) should be waited before the first breast-feeding postpartum and more than 30% of the mothers believe that colostrum should not be given to the newborn, some mothers breast milk could harm their babies, and an evil eye could harm their breast milk. The traditional belief status and educational status of the women differed significantly between provinces, lower educational status and higher rates of women with traditional beliefs were observed in less developed eastern provinces. Overall, 60.6% of the women were knowledgeable on breast-feeding practices, whereas only 13.5% were scored as good in attitudes. Among all women with breast-feed babies, 35.8% started supplementary feeding in the first 3 months of life. Mother's age, education, occupation and traditional beliefs did not have a significant effect on supplementation time. CONCLUSION: As a result, these findings suggest the importance of taking into account the customs, local beliefs and family influences in planning community health programs.

Adolescent↗
PubMed1993

Age of marriage and length of the first birth interval in a traditional Indian society: life table and hazards model analysis.

The length of the first birth interval is one of the strongest and most persistent factors affecting fertility in noncontracepting populations, with longer intervals usually associated with lower fertility. Compared to Western society, the average length of the first birth interval is much longer in traditional Indian society. Yet Indian fertility rates are higher because of either ineffective family planning procedures or deliberate nonuse of birth control and because of the high proportion of the population that is married. Here, we examine the effects of various sociodemographic covariates (with an emphasis on the role of age at marriage) on the length of the first birth interval for two states of India: Assam and Uttar Pradesh. Life table and multivariate hazards modeling techniques are applied to the data. Covariates such as age at marriage, present age of mother, female's occupation, family income, and place of residence have strong effects on the variation of the length of the first birth interval. For each subgroup of females (classified according to different levels of the covariates), the median length of the first birth interval for the Assam (Bengali-speaking) sample is shorter than that of the Uttar Pradesh (Hindi-speaking) sample.

Adolescent↗
PubMed1991

Contraception for women with diabetes: an update.

Today several effective contraceptive methods are available for women with IDDM. Contraceptive guidance as part of the pre-pregnancy counselling needs to be more widely implemented by general practitioners and in non-specialized obstetrical and gynaecological departments. Women with diabetes are generally well motivated, and thus the barrier methods may prove both acceptable and reliable contraceptive agents for some of these women. When, however, a high risk of user failure can be predicted, the IUD or hormonal contraception may be the only reversible alternative. According to our findings, IUDs can be recommended without reservation to women with IDDM. In women with previous GDM it seems that low dose oral contraceptive compounds may be administered without running the risk of inducing glucose intolerance, but long-term results are still unavailable. Natural oestrogens may be administered in combination with a progestogen for a limited period as an efficient and acceptable mode of contraception in women with IDDM without any concomitant adverse effects on diabetic control. From our investigations it also appears that short-term administration of combined low dose OCs containing the traditional progestogens (e.g. norethisterone or levonorgestrel) or the new gonane progestogens (e.g. gestodene) does not alter glycaemic control in women with IDDM. Similarly, these compounds do not cause any significant changes in lipid/lipoprotein levels during short-term treatment, although the intake of monophasic ethinyloestradiol/norethisterone preparations may result in higher triglyceride levels and tends to increase lipid levels more than triphasic ethinyloestradiol/levonorgestrel compounds. The results from our clinic have shown that OCs can be safely recommended at pre-conception counselling so that women with diabetes can obtain both optimal glycaemic control and efficient spacing of their pregnancies.

Contraception↗
PubMed2004

Paradoxical adolescent reproductive decisions.

OBJECTIVE: To determine why teenagers who say they do not plan to parent if they become pregnant fail to use contraceptives consistently enough to avoid conceiving by default. METHODS: A racially diverse group of 333 inadequately contracepting, nulligravida teens, 45 (13.5%) of whom did not plan to parent if they became pregnant was studied. Participants completed scales assessing traditional teen pregnancy risk factors, deterrents to contraceptive use, expectations about the effect of pregnancy, the desire to remain non-pregnant, and sexual behavior. RESULTS: Teens who said they would not parent if pregnant were less apt to report boyfriends who wanted them to conceive (RR=0.7; 95% CI=0.5-0.9) and deterrents to contraceptive use (RRs around: 0.6; 95% CI: 0.3-0.9) and more apt to anticipate that childbearing would negatively impact their lives (RR: 1.9; 95% CI: 1.6-2.2), to want to remain non-pregnant (RR: 2.2; 95% CI: 1.8-2.4), and to have used contraception at last sexual intercourse (RR: 1.8; 95% CI: 1.3-2.4). In the group that did not intend to parent the only difference between those who had and had not used contraception at last intercourse was their willingness to plan for sexual activity (OR: 4.6; 95% CI: 1.3-16.7). CONCLUSION: This study suggests that further progress toward preventing unwanted teen pregnancies might be made by dispelling the notion that for young, unmarried women, unplanned sexual intercourse is preferable to planned sexual intercourse.

Adolescent↗
PubMed1977

Disclosure and informed-consent: does it matter how we tell it?

Traditionally, informed consent has been handled by the physician in a one-to-one interchange with the patient. As standards for adequate disclosure become more rigid and demands on physician time increase, however, the physician-patient model may cease to be practical. This study evaluated four alterative disclosure models: a formal discussion, a videotape, a pamphlet, and an informal discussion, each designed and executed by a team of health educators. Study results suggest that the informed consent process is little affected by disclosure medium and that it may be possible to strive for cost-efficiency in disclosure without compromising the quality of the consent obtained. Based on these results, a two-part disclosure process is proposed which allocates certain aspects of the disclosure to the treating physician, others to health education.

Adult↗
PubMed1981

[The clinical efficacy of the copper-containing intrauterine devices Nova T and Copper-T-200 Ag in a randomized study (author's transl)].

In a randomized study the clinical efficacy of the traditional intrauterine device. Copper-T-200 Ag was compared with the recently developed model Nova T. Altogether 93 women with regular menstrual cycles were examined; 45 women had a Nova T inserted and 48 the traditional Copper-T-200 Ag. The biosocial data of the women in the two groups did not differ from one another. No pregnancies occurred in either group within the first 12 months. Expulsion occurred in 2 women with Nova T and removal of the device had to be undertaken for bleeding and pain in 3 women with a Copper-T-200 Ag. At 12 months the two models did not differ in the number of recorded incidents. The reliability of randomized studies is discussed, as well as problems arising from the fact that the mode of insertion is not identical with both devices and requires practice in the case of the new model.

Female↗
PubMed1981

Trend in vasectomy acceptance: 1974-1981.

It is often heard in Thai population seminars and workshops that Thai men are resistent to vasectomy. There are claims that due to traditional fears of vasectomy or an unwillingness to play a role in family planning most Thai men will not accept vasectomy services even if they are offered nearby. This assumption may be wrong. The Research and Evaluation Unit of the Family Health Division has graphed a new acceptance of vasectomy by month service January, 1974-June, 1981. The graph also plots important events that should be related to vasectomy acceptance. Indeed it appears that when extra effort is made, such as a demonstration mobile team, private sector reimbursement, short-term campaigns and the deployment of mobile teams, willing and waiting acceptors are there. The fact that "extra effort" is required with vasectomy is probably more the result of a general reluctance to undergo the procedure than rather fear or hard-core resistance.

Asia↗
PubMed2002

Medical students as health coaches.

OBJECTIVES: The purpose of this project was to teach students how to work effectively with patients in the area of health-behavior change. As part of the patient-doctor course, first-year medical students worked with diabetic patients who were selected by their primary physicians. In preparation for their patient interactions, students were taught basic communication concepts and the role of the relationship in improving patient outcomes, and continuity issues were addressed as students learned to collaboratively develop behavioral-change plans with their patients and then followed their patients' progress over the course of the year. DESCRIPTION: An educational research trial was conducted to compare the traditional community placement track (shadowing) with the health-coaches track. Students were randomly assigned to the two educational tracks. Health coaches were assigned in pairs to a family medicine patient with diabetes. Under supervision by the patient's medical provider, student pairs worked with the patient in an area of health-behavior change (i.e., weight loss, smoking cessation, exercise, or adherence to medication regimen). Students were required to have at least six patient contacts over the course of a year, consisting of at least three face-to-face visits and including one home visit. Didactic sessions with health coaches taught by either a behavioral consultant or health educator covered the basics of diabetes and behavior-change areas appropriate to respective patients. Students were also given reading assignments from communication and health-behavior change literature and handouts for patients. Behavior-change specialists were available as needed for consultation. In support of the health coaching process, students participated in eight small-group discussion sessions (eight students each) led by a behavioral change specialist. Small-group sessions lasted approximately 90 minutes each and contained didactic and experiential elements. Topics were: "Getting Started" (interviewing, the patient's story), "Fundamentals of a Home Visit," "Changing Behaviors" (stages of change, relapse prevention), "Home Visit Feedback" (report and reflections), "Challenging Patients to Change" (difficulties, challenging irrational ideas), "Giving Direct Guidance," "Non-verbal Skills," "Ending and Celebrating" (terminating the helping relationship). Evaluation methods included a pre- and post-physician belief scale completed by students, pre- and post-provider's evaluation of patient, and a patient-completed health behavior questionnaire. As available, patients' HbA1C levels were compared pre- and post-intervention. DISCUSSION: As expected, initially some health coach students complained about their perceived increased workloads compared with the workloads of students in the shadowing track. Some students also expressed reservations about their abilities to be effective with their patients, but these complaints diminished as students made contact with patients. For many, this opportunity to establish continuity relationships with patients helped students begin to understand difficulties inherent in effecting health-behavior change. Some students expressed appreciation for the opportunity to discuss their increased self-awareness about communication as well as relationship difficulties and strengths during the small-group sessions. Data analysis is under way. Lessons learned from this project influenced a major first-year curriculum revision the following year, resulting in increased emphasis on basic communication skills and the use of small groups to reach a variety of curricular objectives.

Communication↗