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PubMed1992

Assessing potential demand for Norplant implants in Sri Lanka.

This study assesses potential demand for Norplant implants using data from a population-based survey conducted in rural Sri Lanka. Overall, 35% of currently married non-sterilized women of childbearing age expressed interest in using the implants, 52% did not want to use the method, and 13% were unsure about using it. The demand was substantially higher (44% vs 28%) among younger age groups (less than 30 years) than among older age groups (30-44). The results showed that life-cycle variables (age, parity and marital duration) and fertility preference variables (desire for another child and desired birth-interval) were generally more important than socioeconomic variables in determining variations in potential demand for Norplant in Sri Lanka. Desired birth spacing was found to be a powerful indicator of the potential demand. The majority (85%) of respondents interested in using Norplant were also willing to absorb at least some of the cost of the implants. Among older age groups, those who were using modern temporary methods of contraception either exclusively or in combination with traditional methods had a higher demand for Norplant than non-users or exclusive users of traditional methods. For the younger women, however, potential demand did not vary significantly according to whether they were currently using a method or the type of method used.

Adolescent↗
PubMed1997

Condom use banned.

A traditional chief in Swaziland has banned the use of condoms by men in his chiefdom, because they were "misusing and wasting a man's reproductive fluid". The ban, which made front-page news in the Times Newspaper of Swaziland, has shocked nongovernmental organization and family planning officials in the tiny southern African kingdom, the Southern African Press Association reported. Addressing hundreds of his subjects at his Kraal during a visit by health ministry officials, Chief Jameson Ndznatabautfu Maseko said using condoms was against God's laws as stated in the Old Testament. But the chief was willing to continue to allow women to use contraceptive pills, the report said. The chief did not say how he hoped to monitor his male subjects' sex lives but gave instructions that anyone using or being forced to use condoms be reported to him immediately. In a reaction to the chief's comments, health ministry principal secretary, Myekani Vilakati said that if the reports were correct, "the family planning program would have to start all over again, this time starting with educating the country's traditional leaders".

Africa↗
PubMed1997

Traditional fertility regulation among the Yoruba of southwestern Nigeria. I. A study of prevalence, attitudes, practice and methods.

This study was conducted among Yoruba women and traditional healers with the aim of identifying and describing the practice, preparation, and administration of traditional contraceptives. The data were obtained in 1990 from a random sample of 1,400 women of childbearing age and 42 traditional healers in Nigeria's Oranmiyan area, using questionnaires and in-depth interviews. Findings revealed that knowledge of the traditional contraceptives is nearly universal among the Yoruba population, and the traditional contraceptive prevalence rate is 7.1 percent. The use of traditional contraceptives was significantly more common among uneducated women and among women aged 20 to 29 years old. Findings also revealed the existence of four main varieties of traditional contraceptive devices, the methods of preparation of the traditional contraceptives, varieties of herbal and animal products used, methods of administration, and taboos against usage. The easy accessibility of traditional medical practitioners and the belief that traditional contraceptive devices are devoid of complications, especially among those experienced with modern contraceptive devices, were the main reasons women cited for patronizing the traditional practitioners. The paper concludes with policy implications for family planning programmers in Nigeria.

Adolescent↗
PubMed2004

Women's autonomy, education and employment in Oman and their influence on contraceptive use.

Since 1970 political and economic changes have brought about great improvements in health and education in Oman, and since 1994 the government has provided free contraceptives to all married couples in primary health care centres. Despite rapid socio-economic development, the fertility rate was 4.2 in 2001. The aim of this study was to define baseline data on ever-married women's empowerment in Oman from a national study in 2000, analyse the correlates of women's empowerment and the effect of empowerment on unmet need for contraception. Two indicators of empowerment were used: women's involvement in decision-making and freedom of movement. Bivariate analysis was used to link these measures and their proxies, education and employment status, with use of a family planning method. Education was a key indicator of women's status. Unmet contraceptive need for women exposed to pregnancy was nearly 25%, but decreased significantly with educational level and paid employment. While empowered women were more likely to use contraception, women's education was a better predictor of "met need" than autonomy, as traditional factors and community influence remain strong. For nearly half the 1,830 women in the study, the husband decided whether contraception was used. Fewer than 1% were using contraception before their first child as women are expected to have a child within the first year of marriage.

Adult↗
PubMedDate not supplied

Utilizing grassroots workers in family planning programs in India: prospects and problems.

In order to rapidly expand the network of delivery systems and speed up the process of acceptance of family planning messages and methods, a shift took place in the Indian family planning program from the bureaucratic "clinical" approach to the people oriented "extension" approach. As a result, there is an increasing emphasis on moving the family planning efforts closer to the grassroots level. A key methodological issue centers on the proper selection, cultural acceptability, and the effectiveness of the grassroots workers who are to be trained and through whom family planning motivational messages and methods are to be introduced. The Indian government, from time to time, has trained and utilized different groups of grassroots workers in its family planning promotional efforts. Anthropological field studies were conducted in two different regions in India to examine the potential and actual roles of two groups of grassroots workers--opinion leaders and traditional birth attendants--in the delivery of family planning services in the rural areas. These studies revealed that while the traditional birth attendants can be trained and utilized to a limited extent in promoting family planning efforts, especially to the eligible female clients, the role of the opinion leaders in such efforts is at best questionable. Based on these field studies, cultural and technical (including bureaucratic) problems in training and utilizing opinion leaders and traditional birth attendants are explored in detail. Modifications in the training program strategies are suggested to improve and expand the family planning delivery system in rural India.

Advertising↗
PubMedDate not supplied

Use of traditional medical practitioners to delivery family planning services in Uttar Pradesh.

This pilot study conducted in Muzaffarnagar district in the state of Uttar Pradesh, India, demonstrates the potential for using traditional medical practitioners in the delivery of family planning services after a brief training period. Practitioners participated continuously in the program for an intervention period of two years during which their services were accepted by the community. The impact of their involvement was reflected in increased knowledge of permanent as well as reversible contraceptive methods and in higher contraceptive use rates, especially of reversible methods adopted by women younger than 25 years (from 8 percent to 37 percent), in the intervention villages, as compared with increased knowledge and use (from 13 percent to 25 percent) of permanent methods alone in the control villages.

Adolescent↗
PubMed1998

Men's views on male hormonal contraception-a survey of the views of attenders at a fitness centre in Bristol, UK.

The last three decades have seen a significant move in Western society away from traditional gender roles. How do these role changes extend to the area of family planning? Family planning researchers and service providers have focused almost exclusively on women. Scientific research is being undertaken to develop a hormonal contraceptive for men. Service providers should be asking the question: How will UK men respond to a reversible hormonal contraceptive method for males? The aim of the study is to begin answering this question. A descriptive survey explored the view of a sample of UK men towards a future, hormonal contraceptive method. Self-administered questionnaires were distributed through convenience sampling to 250 men. The response rate was 46 per cent (115). In terms of preference of contraceptive methods, the 'male pill' ranked third as a first choice and ranked first as the second choice. The results indicate that couples in an established relationship may be the appropriate target group for a 'male pill'. The tablet form was the preferred delivery method for a future male hormonal contraceptive. Perceived side effects were not well tolerated with 71 per cent (81) of respondents not prepared to tolerate any. The majority (94 per cent) expected health monitoring and 38 per cent of men were willing to pay between 5-10 per month. The results indicate a potential uptake of a future 'male pill', with couples in an established relationship as an appropriate target group. However, the study was based on a sample which was small and biased towards middle-class professionals. Further research is needed which covers a wider geographical area representing all social groups and includes women.

Adult↗
PubMed2006

Implementation of evidence-based practices for children in four countries: a project of the World Psychiatric Association.

OBJECTIVE: The present study examined implementation issues in adopting cognitive-behavioral therapies in routine clinical settings in four countries reflecting diverse cultures, languages, settings, and traditions. METHOD: A Director's Systems Survey was administered prior to program implementation and one year later. Therapist ratings on attitudes about evidence-based practices and satisfaction were also gathered. RESULTS: All sites reported successful adoption of the program, although significant variations existed in fiscal support, family involvement, prior experience with cognitive-behavioral therapies, and plans for sustainability. Therapists' ratings indicated overall satisfaction with the implementation of the project. Findings from the Director's Systems Survey pointed to five factors facilitating implementation: 1) early adoption and guidance by innovative leaders (i.e., the Directors); 2) attention to the "fit" between the intervention model and local practices; 3) attention to front-end implementation processes (e.g., cultural adaptation, translation, training, fiscal issues); 4) attention to back-end processes early in the project (e.g., sustainability); and 5) establishing strong relationships with multiple stakeholders within the program setting. CONCLUSIONS: The implementation issues here mirror those identified in other studies of evidence-based practices uptake. Some of the obstacles to implementation of evidence-based practices may be generic, whereas issues such as the impact of political/economic instability, availability of translated materials, constitute unique stressors that differentially affect implementation efforts within specific countries.

Child↗
PubMedDate not supplied

Contraception and culture: the use of yuyos in Paraguay.

The use of herbs (yuyos) as contraception is common practice in Paraguay. This report analyzes data from the 1995-1996 Paraguayan Reproductive Health Survey. The analysis reveals that women are more familiar with yuyos (88%) than any other method of family planning. Modeling the determinants of ever having relied on yuyos as contraception demonstrates that older women (OR = 1.043) and women with more children (OR = 2.283) are significantly more likely to have used yuyos, but an interaction between older women with more children shows they are less likely to have used this method (OR = .982). Women living in rural areas (OR = .664) and those with more education (OR = .883) are less likely to have used the method. These findings show widespread acceptance and use of yuyos for contraception in Paraguay. More research into the chemical properties of yuyos is needed to determine their contraceptive efficacy and to prevent harmful effects from their misuse.

Adolescent↗
PubMed2002

[Inpatient postpartum nursing: evaluation of "holistic" and "traditional" nursing processes in the post partum period].

During the last years one could observe a change in the organisation of postpartum care at hospitals in Germany. Maternity hospitals implement new models of care which they call "holistic", "integrated" or "family centered" care. The reasons for the implementation are various. The desire for an optimal care has surely to be mentioned in the first place, but social changes and changes in health politics like the shortening of the lengths of hospital stay after a normal birth and the demand for quality assurance are also very important. But what does the "new model of care" mean for mothers, their children and their families and for the staff? What effects have the new models of care in comparison with the traditional ones? Will the goals be achieved? A formative programme evaluation was chosen in order to investigate these questions. To do justice to the research plan, to the complexity of the field of research and to produce valid results, three qualitative methods were applied: (keywords: triangulation: time triangulation, within-method-triangulation): participant observation, problem-oriented interview according to Witzel and document analysis. The evaluation of the data followed the method of qualitative content analysis developed by Mayring. As a whole, the results suggest that the new model of care has not produced the changes and not left the impression and effects on the mothers and the staff the hospital and the supporters had hoped for.

Adult↗
PubMed1997

Positive practice in family therapy.

Positive practice, a brief integrative approach to consultation with families, is described in this paper. A clear distinction is made between the stages of planning, assessment, therapy, and disengagement. Guidelines for progression from one stage to the next are provided. Frameworks for deciding who to invite to preliminary sessions and methods for planning and organizing lines of inquiry are incorporated into this approach to practice. A three-column model is used to construct formulations. The model allows therapists and clients to map information about the pattern of interaction around the presenting problem, beliefs that constrain family members from altering their roles in these problem-maintaining patterns, and factors that have predisposed family members to hold these beliefs. Positive practice offers methods for evolving new behavioral patterns and belief systems within sessions and for arranging homework tasks for clients between sessions. It also incorporates methods for dealing with resistance, for managing therapeutic crises, for convening individual sessions and broader network meetings, for disengaging from the consultation process, and for recontracting for further episodes of therapy. This evolving approach to practice draws on ideas from many traditions within the family therapy field and takes account of recent research relevant to the practice of family therapy.

Adult↗
PubMed2001

Pulmonary rehabilitation after acute COPD exacerbation.

Acute COPD exacerbation provides a window of opportunity for providing teaching, supportive care, and rehabilitation to a group of patients at high risk for complications and re-admissions. This article has attempted to make a case for the unique needs of this group of patients. Treatment of exacerbation is often viewed as "routine" by hospital staff and generally has focused upon the pharmacologic regimen of oxygen therapy, bronchodilators, antibiotics, and steroids. Within a few days, the patient is usually less dyspneic and is discharged with a combination of MDIs and a plan for steroid taper. All too often, the patient returns home with no idea of how to regain lost function or prevent future exacerbations. The use of the MAC provides a more complete picture of the unique needs and capabilities of COPD patients and brings together the collective expertise of the entire health team in designing a plan of rehabilitative care. Planned monitoring of the patient after discharge is an integral component to the success of the rehabilitation approach and the ability of the patient and family to move toward self-management of this chronic disease. Transitional care programs, community nurse referrals, telephone contacts, and outpatient visits are all appropriate methods for providing the type of support required to sustain rehabilitation. Traditionally, nurse researchers have examined psychosocial and functional performance outcomes of rehabilitation, however, nurses are in an ideal position to explore the methods of rehabilitation that yield the most positive outcomes over time and are sustainable over the course of the disease. Nursing can and should assume a leadership role in such initiatives.

Exercise Therapy↗
PubMedDate not supplied

A study of the beliefs and birthing practices of traditional midwives in rural Guatemala.

This is a descriptive study of the beliefs and practices of the traditional midwives in a rural Guatemalan village. During pregnancy and birth, traditional midwives who have received minimal or no training attend more than 80% of the indigenous Mayan women. Data were obtained from interviews with the midwives and from direct observation of midwives attending births. The midwives had few skills with which to handle complications. They failed to use basic aseptic technique and were unfamiliar with lifesaving skills such as fundal massage and proper infant stimulation. Even though most of the midwives interviewed had attended a Ministry of Health training course, they lacked basic knowledge of safe obstetric practices. To reduce infant and maternal mortality rates, traditional midwives must be adequately trained. The teaching methods used by an indigenous Guatemalan group training elderly, illiterate midwives are described as an example of an effective training program.

Adult↗
PubMed2002

A population-based, cross-sectional survey of the Zuni Pueblo: a collaborative approach to an epidemic of kidney disease.

Approximately 80% of the Zuni Indians live in Zuni Pueblo in rural New Mexico. The Zuni are relatively endogamous and differ culturally and ethnically from neighboring tribes. The Zuni Pueblo is experiencing an epidemic of renal disease. The prevalence of end-stage renal disease (ESRD) among the Zuni Indians, adjusted for age and gender, is 6-fold and 21-fold higher than the prevalence rates for Native Americans and European Americans. Almost all Zuni tribal members have a relative with ESRD. This has led to strong public support for renal research. In response, the Zuni community has partnered with the Indian Health Service (IHS), University of New Mexico Health Sciences Center (UNMHSC), Southwest Foundation for Biomedical Research (SFBR), Dialysis Clinic Inc (DCI), and the National Institutes of Health (NIH) to establish a research consortium, the Zuni Kidney Project (ZKP). The goal of the ZKP is to reduce the burden of renal disease in the Zuni community. The ZKP combines traditional, population-based, epidemiologic methods with modern techniques of population genetics. The foundation of the ZKP is a population-based, cross-sectional survey (PBCSS). The PBCSS has 3 specific aims: (1) estimate the prevalence of renal disease in Zuni; (2) assess risk factors for renal disease susceptibility; and (3) identify participants for planned case-control, longitudinal cohort, and family studies designed to identify environmental, familial, and genetic risk factors for the susceptibility and/or progression of renal disease. Preliminary results of the PBCSS confirm that the epidemic of renal disease in Zuni Indians is due to high rates of both diabetic and nondiabetic renal disease.

Adolescent↗
PubMed1990

An alternative methodological approach for studies in family planning.

"An alternative to the methodological approach traditionally used in studies on family-planning practices was developed and applied in a retrospective investigation of the decision making of a sample of women [in South Africa] regarding their adoption of contraceptive sterilization. The approach is based on the premise of an interparadigmatic overlap and makes provision for integrating analytical levels and employing a combination of quantitative and qualitative research methods in a research design.... The results of the investigation showed the respondents' perceptions of the most important reasons for their decision to be sterilized. The findings provided insight into the interdependence of the sample's fertility behaviour and societal modernism within the particular institutional and socio-cultural setting." The data are from a survey carried out in the Cape Peninsula. (SUMMARY IN AFR)

Africa↗
PubMed1986

Education and the new technologies in reproduction.

Since 1978 technologies applied to human reproductive biology have resulted in totally new ways of making families. Traditionally education has presented science as a value-free body of absolute knowledge, neatly divided into discrete disciplines. This has resulted in a fragmented approach to the teaching of human reproduction. Many students are leaving school today confused and ignorant about contraception and their own fertility. How will education deal with new methods of controlling and promoting human fertility and family planning? Should the curriculum include: the scientific details of the technologies; the nature and known causes of infertility; the recent legislation designed to limit these technologies; the implications for the family as the fundamental social unit? If so, where in the curriculum, and taught by whom? This paper critically examines these possibilities with particular focus on the confused role of genetics in defining parents and families, both in the literature and in recent Victorian legislation designed to regulate new reproductive technologies. A more precise definition of the concept of 'mother' which acknowledges all three components, genetic, birth and social is suggested for inclusion in a broader curriculum about human reproduction, preferably within science education.

Australia↗
PubMed2000

The role of couple negotiation in unmet need for contraception and the decision to stop childbearing in Uganda.

This study uses survey and focus-group data from the 1995-96 Negotiating Reproductive Outcomes study in Uganda to describe the nature of the decision to stop childbearing and to question the simplifying assumption of consensus decision-making implicit in much demographic research on unmet need. Negotiation is characterized in four stages, from normative precedent for decision-making to communication, disagreement, and conflict resolution. Indirect forms of communication between partners predominate, contributing to the tendency of both men and women to overestimate each other's demand for additional children. Partner opposition is found to cause a statistically significant increase in unmet need reported by women and a shift in contraceptive mix favoring use of traditional methods over modern methods. For women, partner opposition may account for as much as 20 percent of unmet need in urban areas, 12 percent in rural areas, and 15 percent overall.

Adult↗
PubMed2000

Continuing medical education-driven skills acquisition and impact on improved patient outcomes in family practice setting.

BACKGROUND: An abundance of educational theory, design, and delivery of continuing medical education (CME) learning interventions, including their impact on learners, are described in the health and social sciences literature. However, establishing a direct correlation between the acquisition of new skills by learners and patient outcomes as a result of a planned CME learning intervention has been difficult to demonstrate. METHODS: The learning intervention described here tested the impact of an injection skills-acquisition program for family physicians treating osteoarthritis of the knee by measuring patient outcomes using the pain and function subscales of the Western Ontario and McMaster (WOMAC) 3.0 osteoarthritis index, a standardized and fully validated patient-centered outcome measurement. It was hypothesized that patients of family physicians who participated in this skills-acquisition CME program would benefit from treatment administered by their physician during the time between injection skills acquisition to 6 weeks post-injection. Inclusion of a validated health status measure administered pre- and post-injection in addition to more traditional faculty and participant program evaluations was deemed necessary to test this hypothesis. Rheumatology, orthopedic surgery, and family medicine specialists from across Canada were invited to contribute to the planning, curriculum elaboration, and delivery of the viscosupplement injector preceptorship (VIP) program. Thirty-nine orthopedic and rheumatology specialists agreed to serve as expert faculty and participated in training 474 Canadian family and general practitioners over 8 months. The learning intervention involved a review of pertinent literature by a local preceptor and a summary of recommendations of the planning committee, followed by demonstration of injector skills and then supervised practice with patients, who received hylan G-F 20 (Synvisc, Ridgefield, NJ) usually in the offices of the family physicians. The pain and function subscales of the WOMAC 3.0 questionnaire were self-administered to each patient in their physician's office, prior to receiving their joint injection and again at or near 6-weeks post-injection. Data were analyzed in the Department of Epidemiology and Biostatistics at The University of Western Ontario, London, ON. RESULTS: Clinically important statistically significant improvements in pain and physical function were noted in patients who received viscosupplementation treatment from family physicians who had recently acquired the necessary injection skills. Approximately three-quarters of the patients experienced a reduction in pain and an improvement in physical function of at least 20%. IMPLICATIONS: These results suggest a positive relationship between acquisition of a new skill by learners and improved patient outcomes as a result of this planned CME learning intervention.

Adrenal Cortex Hormones↗