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PubMed1995

Women's health.

Although women live longer than men, new evidence indicates women bear a disproportionately heavy burden of disease. The effect of disease on economic productivity of women in developing countries has been largely ignored. Infections are often causes of disease in women, including those that affect reproductive health. Although men and women usually experience similar rates of many diseases, rates of exposure and treatment vary between men and women. If untreated, factors adversely affecting women's health in one stage compound women's ill health in succeeding stages.

Abortion, Legal↗
PubMedDate not supplied

[An alternative model of health sciences in relation to women].

BACKGROUND: The purpose of this article is to present an alternative medical model to the hegemonic model, from the point of view of gender. Gender is believed as a socio-cultural construction defining men and women ways of behaving in society at a definite historical time. Gender consideration in epidemiologic analysis, together with other social variables, constitutes a new approach in the knowledge of women practices. Gender values are the basis to transform social relations and health care within the health system. The position I show includes a macrosocial level: the State and social politics, and a microsocial level: woman and her connection with the doctor in her daily life scope. METHODS: A content analysis of the compiled bibliography was carried out from the point of view of gender. A Primary Health Care Center belonging to a marginal district in the City of Buenos Aires, Argentine was taken as reference. RESULTS AND CONCLUSIONS: As result of this study, a woman care typology, emphasizing the differences between an hegemonic medical model and an alternative model, was elaborated. In the same way, concepts, which may be a guide in the construction of an alternative model to the hegemonic one, are handled.

Argentina↗
PubMed1994

Prenatal diagnosis and management of the fetus with an abdominal wall defect.

Prenatal ultrasound has advanced our understanding of congenital abdominal wall defects. In addition to providing insights into the divergent embryological origins and natural history of abdominal wall defects, ultrasound has had an important impact on the management of these anomalies. For fetuses with gastroschisis, the changes in appearance of the bowel may suggest expeditious delivery. In cases of omphalocele, the presence of additional anomalies is significantly associated with the ultimate prognosis for these fetuses. Giant omphalocele may preclude vaginal delivery secondary to dystocia. Exstrophies of the cloaca and bladder are rare congenital abnormalities that often present complex management issues, including gender reassignment in cases of cloacal exstrophy, for those couples wishing to continue the pregnancy. We believe that the optimal management of a fetus diagnosed with an abdominal wall defect requires a coordinated effort among specialists from maternal fetal medicine, pediatric surgery, and pediatrics.

Abdominal Muscles↗
PubMed1993

Safe sex? Misconceptions, gender differences and barriers among injection drug users: a focus group approach.

Heterosexual transmission is one factor involved in the spread of the human immunodeficiency virus (HIV) within the injection drug use (IDU) population and between IDU and non-IDU individuals. Insufficient information is currently available to reduce this heterosexual transmission. As a basis for designing a questionnaire aimed at the IDU population, we conducted 5 focus groups to collect information on knowledge of and attitudes toward safe sex as held by male and female IDUs in methadone treatment. We identified misconceptions related to HIV infection, condoms, and sexual behavior. We also found gender-based differences in knowledge and learning style. Also, while individuals felt a responsibility to prevent HIV transmission, they lacked sufficient control to do so. The wide range of responses on questions concerning sexually transmitted diseases (STDs), condoms, reproductive decisions, and methods of promoting safe sex provides a basis for developing a questionnaire designed to identify and target specific subgroups for educational intervention.

Adult↗
PubMedDate not supplied

Mammography and Pap smear screening of Yaqui Indian women.

The Pascua-Yaqui Tribe of Arizona receives its health care services at a local neighborhood health center in Tucson and a satellite clinic located on the reservation. Using a computerized data base from the health center, the authors determined the use rates by Pascua-Yaqui women ages 35-65 of the Papanicolaou smear and mammography screening. Among active users of the health center, 31-36 percent had received a Papanicolaou smear, according to the yearly data bases examined from 1986 to 1990, while 65 percent of the women had received at least one smear test over the entire 5-year period. Regarding mammography screening, 41-43 percent of the women ages 50-65 had received a mammogram in the years studied, and 51-58 percent of the women ages 40-49 had been screened. In all, 67 percent had received at least one mammogram during the 1988-90 period when the center offered mammography. This population of 35-65-year-old American Indian women, for whom financial access is not a barrier, were receiving Papanicolaou smears and mammograms at rates comparable with other segments of the U.S. population but at lower rates than those recommended by the American Cancer Society and National Cancer Institute. The challenge for the health center is to reach those women who are eligible for services but do not use them and to address the nonfinancial barriers to care such as language, transportation, and gender-specific issues.

Adult↗
PubMedDate not supplied

HIV sexual risk reduction interventions for women: a review.

AIDS has emerged as a serious public health threat for women. Reducing the risk for HIV infection among sexually active women requires the adoption of preventive strategies that effectively inhibit viral transmission. However, there is a paucity of published literature describing interventions targeted toward women and even fewer published reports evaluating their effectiveness. We conducted a search of HIV prevention interventions for women using the MEDLINE, ERIC and PSYCHLIT on-line computer database for the years January 1984-May 1995 to assess the effectiveness of interventions in increasing condom use during sexual intercourse. Interventions efficacious at increasing condom use applied a social psychological model of behavior to guide the development and implementation of the intervention, used randomized controlled designs to evaluate program efficacy, emphasized gender-related influences, were peer-led, and used multiple intervention sessions. While these findings are promising, methodologic limitations preclude any definitive assessment of programmatic efficacy. One challenge for future studies is to corroborate and extend these findings using rigorous methodologic research designs to evaluate programmatic efficacy, in particular, longer follow-up to assess stability of treatment effects over time. Another challenge is to understand the implications of previous research for the development of more gender-relevant interventions. The urgency of the HIV epidemic demands that the development and evaluation of HIV-prevention interventions tailored toward women remain a public health priority. Medical Subject Headings (MeSH): women, HIV/AIDS, interventions, prevention.

Adolescent↗
PubMed1996

The interaction of ethnicity, sociocultural factors, and gender in clinical psychopharmacology.

There is increased interest in the role that ethnicity, sociocultural factors, and gender play in research, health care delivery, and response to intervention. The impact of these factors on AIDS awareness programs, on the phenomenology of suicide and anorexia nervosa, and on clinical psychopharmacology in a homogeneous population is discussed. Risky sex practices can be related to cultural norms that stigmatize condom use and sex education; economic deprivation; and male dominance. Gender, cultural, and ethnic demographics can identify high-risk groups as well as influence effective interventions. Suicide rates and risk factors are compared in African-American, Canadian Native, and South Korean adolescents. Academic stress was a differential risk factor for the Koreans. Anorexia nervosa predominantly affects women and has cultural differences in prevalence. The homogeneous population in Hong Kong illustrates the impact of ethnicity, sociocultural factors, and gender on clinical psychopharmacology. Attention to ethnicity, sociocultural factors, and gender can individualize and improve the effectiveness of clinical psychopharmacology.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Venereology as a specialty in Australia.

The development of venereology as a medical specialty began in 1979-1981 with the formation of multidisciplinary venereology societies in each state, followed by annual convention of an advocacy body, the National Venereology Council of Australia, which also included governmental representatives. In 1988 the Australian College of Venereologists was incorporated as a professional training body, and in 1992, the first Chair in Sexual Medicine was established by the Universities of Sydney and New South Wales. In parallel, the role of the nursing profession as active participants evolved dramatically: nurses work within the context of the health care team, with clinical, teaching, and outreach responsibilities, and by collaborating or initiating research. Sexual and Reproductive Health nursing is recognised as a specialist area, and the Australian Sexual Health Nurses Association (ASHNA) was inaugurated in 1991. Sexual Health Counselors come from a range of disciplines which represent the shift in focus from disease control to education and prevention, and which encompass sexual dysfunction, gender identity issues, sexual assault, and the empowerment of clients. Within the repertoire of many health care workers in sexually transmissable disease services are skills in the ¿new¿ public health (particularly health promotion), and an understanding of cultural influences on sexuality. ¿Sexual Health¿ has become the preferred name for such services.

Australia↗
PubMedDate not supplied

Quality health care for women: a global challenge.

This paper discusses barriers to the provision of high quality care from the perspectives of the health system and female clients, and interventions that have been developed to overcome these barriers. These interventions are in the area of reproductive health, where most attention to women's health has focused; they consist mainly of assessment tools that can be used by peripheral health workers and rural women themselves. The paper argues that in nonreproductive health generally, there is a dearth of information on the biological and social determinants and consequences of infection and disease from a gender perspective. Recommendations are made for further research on quality of care and for practical interventions with application to women's health, both within and outside the reproductive context.

Female↗
PubMedDate not supplied

Gender differences in HIV-related self-reported knowledge, attitudes, and behaviors among college students.

A survey of 265 college students was conducted to determine HIV-related knowledge, attitudes, behavior, and perceived self-efficacy with regard to engaging in HIV-protective behaviors. A self-administered 52-item survey was completed by 265 college students (60% response rate). Resident advisors in college dormitories distributed the survey, returned anonymously. Data were analyzed using SPSS to identify differential responses by gender. Although HIV knowledge was high, perceived self-efficacy differed significantly by gender, with men describing themselves as less able to insist upon condom use (P < .00001). Men were also significantly more likely to report using drugs or alcohol in situations likely to lead to a sexual encounter (P < .001) and to having lower self-efficacy in relation to HIV protection than women in such situations (P < .02). Men were also significantly more likely to believe that monogamy obviates the need to use condoms (P < .01). A substantial number of men (13) and women (14.6) say they do not use condoms because they are protected from unwanted pregnancy by pill. Gender-specific HIV education and skills-building programs may improve the success of AIDS prevention efforts by confronting and addressing gender differences. The reliance on hormonal methods of birth control alone may be a barrier to condom use for both male and female adolescents and young adults. Medical Subject Headings (MeSH): AIDS; HIV; knowledge, attitudes, and practice; gender; condoms; birth control; family planning; teenage pregnancy.

Adult↗
PubMed1996

Women and AIDS in south and South-East Asia: the challenge and the response.

South and South-East Asia are at the centre of the most aggressive advances of the AIDS epidemic today. The challenge this presents to the region is clear. While reported absolute numbers still lag behind the African region (11,160,900 in Africa; 3,081,235 in Asia) knowledgeable observers agree that the place of infection and potential devastation in this region exceed what we have seen in Africa. Those concerned with the welfare of the people of Asia, therefore, must make serious efforts to break the chain of HIV transmission as quickly and effectively as possible and identify and care for the infected. Women are entitled to protection by rights the same as men. However, for anatomical reasons, women are more vulnerable than men to infection by HIV. In addition, throughout the Asian region, women's "natural" vulnerability is vastly magnified by poverty and generally low levels of education and personal autonomy which make it difficult for them to gain access to information and appropriate services. Because of women's multiple roles in the epidemic-potential "infectee", care-giver, transmitter of infection-if we are to be successful in halting the spread of HIV/AIDS we must give particular attention to reaching, working with, and serving women. Meeting this challenge requires involvement of men as well as women, individuals and institutions, governments and NGOs, in four broad areas of activity: (i) HIV/AIDS education and information; (ii) basic education and economic activity to reduce gender inequities; (iii) improvements in policy and social environments; and (iv) provision of health and other services. Lack of commitment, skill, or persistence in meeting the challenge will cost lives across Asia.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Double jeopardy: women and leprosy in India.

This article presents evidence from two states of India, Bihar and Maharashtra, on the process of "dehabilitation" among male and female leprosy patients, and suggests gender-sensitive interventions to address existing problems in leprosy control. While the study investigated a wide range of gender differences in the impact of leprosy, this article focuses on only two-marriage and family reactions. Important gender differences were apparent in the impact of the disease. While both men and women were negatively affected in terms of their family and marital lives, women suffered more isolation and rejection. Psychologically, women appeared more vulnerable because they were deprived of personal contact with others in the domestic environment where they were accustomed to receiving their greatest emotional rewards. Women reported that indifference to them by other family members, or seeming negation of their presence, caused them the greatest suffering. This underscores the importance of providing information to both leprosy patients and their families about the disease and its treatment, including the possibility of cure with MDT (multi-drug therapy) and of counselling family members about their crucial role in helping patients cope and recover. This support is even more critical for women, who often lack access to the variety of outside advice and assistance available to men. The evidence presented in the article demonstrates the importance of analysing leprosy from a gender perspective, not only because this approach helps to inform our understanding of the determinants and consequences of the disease, but also because it provides new insights for improved disease control.

Adolescent↗
PubMed1996

Gender dynamics and the challenges for HIV prevention.

Information on the transmission of the human immunodeficiency virus (HIV), leading to acquired immunodeficiency syndrome (AIDS), has been widely disseminated since the early 1980s, and yet curbing new infections remains a major public health dilemma. In response to the global challenge of HIV/AIDS, most control and prevention interventions have targeted "core groups' with messages which include:- 1. Reduction of individual risk through responsible sexual behaviour or behaviour change, such as, delayed sexual debut, abstinence, monogamy and condom use. 2. Communal (as a society) adoption of a risk reduction strategy e.g. reduced rate of sexual partner change and avoiding multiple partners. 3. Improved, early and aggressive STD treatment programmes. However, data from sub-Saharan Africa and elsewhere shows how the epidemic, in the general population, appears to thrive unabatted. Large proportions of women and some men, in none of the traditional high risk core groups, are increasingly becoming infected with HIV. Most of the women appear to be at risk of infection not so much because of their own behaviour, but that of their partners of husbands. In this continuum, our response has been fragmented and non-strategic. Few programme activities have been developed that address men as a critical core group potentially propagating or sustaining the epidemic. The preoccupation with female sex workers and other core groups (e.g. truck drivers) could have overshadowed the need for programmes and interventions that make men, in general, aware of HIV risk and less likely to infect their sexual partners. Challenges posed by HIV require innovative strategies that foster behavioural and social change in the situation of men at risk and their partners.

Africa South of the Sahara↗
PubMed1996

Knowledge and attitudes toward sexuality in adolescents and their association with the family and other factors.

Family structure and function and their association with knowledge and attitudes toward sexuality, contraception, and sexually transmitted diseases (STD) were studied in 918 students and 312 adolescents working in factories. Unmarried workers reported higher rates of sexual activity than did students (30.9% vs. 21.8%, p = .04 for males; 12.9% vs. 6.0%, p = .005 for females). Among sexually active males, 33.3% of students and 30.7% of workers used contraception, compared with 27.5% of female students and 9.5% of female workers. Workers were from larger families than students, and the male and female workers had lower scores for knowledge on sexuality, contraception, and STD than did students. Multiple stepwise regression showed that age and schooling of the parents were associated with knowledge and attitudes in the students. In workers, the position of the child in the family was a negative regressor for attitudes and knowledge on sexuality in males, and for knowledge on contraception and STD in females. In regard to family function, the significant factors were compromise between the parents, positive affective response, communication within the family, problem solution, and control of behavior. It was concluded that female workers are at higher risk for unwanted pregnancies and STD. The factors associated with knowledge and attitudes were age, schooling of the parents, mother working out of home, position of the adolescent in the family, and the diverse aspects of family function.

Adolescent↗
PubMed1997

Estimates and explanations of gender differentials in contraceptive prevalence rates.

This article examines gender differentials in the reporting of contraceptive use and offers explanations regarding the sources of these differences. Data from five countries where DHS surveys were conducted recently among men and women are used in exploring these differences. The gap exists in all five countries, with men (or husbands) reporting greater practice of contraception than women (or wives). Results from the bivariate analysis suggest that the gap is attributable to polygyny and to gender differences in how the purpose of contraception is understood, rather than to male extramarital sexual relations. Additionally, gender differences in the definition of certain contraceptive methods and differences in the interpretation of questions about contraception contribute to the observed gap. These findings are also consistent with results of the multivariate analysis.

Africa↗