Ethical and health implications of directive counseling on long-acting contraception.
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Biomedical subjects
Publications and source records attributed to S L Isaacs.
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A national survey designed to find out what information people want before they choose a health plan revealed significant differences between men and women. Women were the more knowledgeable and astute health plan consumers. They read the materials about health plans and needed more detailed and pertinent information than men. This is not surprising since, in general, women use the health care system more than men; they bring children to the pediatrician, care for older parents, and visit physicians while they are healthy. The survey demonstrates the need for the health care industry to give consumers, particularly women, better information about health plans. It also provides a basis for moving the concept of women's health beyond reproduction to include health care in its entirety.
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A national survey conducted in 1995 found that a disturbingly high percentage of Americans do not understand the basic elements of health plans and that people want much more information, particularly about the physicians in the plans and the range of services that are covered. Their most important concern when selecting a health plan is the quality of physicians in the plan, followed by the courtesy of doctors and staff and the freedom to choose their own doctors and hospitals.
Pyramidal neuron density was determined at autopsy in the brains of 12 neurologically normal patients (age range 6-87 years) and 18 patients with histopathologically confirmed Alzheimer's disease (AD; age range 62-89 years). Paraffin wax sections were cut at the level of the central part of the cornu ammonis and stained with cresyl fast violet. Pyramidal neuron density was determined in the stratum pyramidale of the presubiculum, subiculum, prosubiculum and CA1-4. The width of the stratum pyramidale in these areas was also determined. There was no significant effect of age on pyramidal neuron density in any of the fields of the hippocampal formation. However, there was a significant decrease in pyramidal neuron density in the subiculum (44%), prosubiculum (28%) and CA1 (41%) of AD brains compared to controls. There was no significant effect of AD on pyramidal neuron density in the presubiculum, CA2 and CA3, but in CA4 it increased (23%) significantly. Pyramidal band width decreased significantly with age in the presubiculum but there was no effect of age on any other region of the hippocampal formation investigated. The width of the stratum pyramidale was significantly lower in the presubiculum (19%), subiculum (30%) and CA3 (17%) of AD compared with control brains. These data suggest that a reduction in pyramidal neuron density within the hippocampal formation does not occur in the absence of underlying pathology. In AD, pyramidal neuron loss predominantly occurs from that sector of the hippocampal formation which comprises the subiculum, prosubiculum and CA1.
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Anxieties about financing health and family planning programs have grown in recent years, leading to discussions of cost-recovery measures that would raise charges to the consumer. Yet some governments wish to lower cost to encourage contraceptive use, and a few use incentives and disincentives. Data from numerous developing countries are presented on contraceptive cost topics: charges for contraceptive supplies and services, in both public and private sectors, and conversely, payments made to clients and providers to offset costs and to increase contraceptive use. The data show great diversity, and much inconsistency within countries, indicating that the structures of charges, payments, and incentives in many programs could be improved. Ethical considerations are discussed, and guidelines are suggested for developing effective financial policies.
A central challenge in developing reproductive health strategies is giving real meaning to the right of couples and individuals to determine, freely and responsibly, the number and spacing of their children. This article places the right of reproductive choice in legal and historical contexts, highlights salient issues that arise in trying to formulate international standards for its enforcement, and examines two particularly thorny issues: the tension between demographic priorities and reproductive choice and the tension between international standards and local custom/religion. The article calls on health professionals to participate actively in the elaboration of reproductive rights, both through their immediate work in the health-care field and through involvement in the international policymaking process that will take place in three upcoming international conferences.
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