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PubMed1995

Effectiveness of the non-spermicidal fit-free diaphragm.

Standard instructions for diaphragm use call for an individually sized latex diaphragm, used in conjunction with spermicide jelly. However, some investigators have reported that the diaphragm can be effective without a spermicide. A non-randomized trial designed to measure the contraceptive effectiveness of the diaphragm used without spermicide was conducted. A total of 110 self-selected women were enrolled to use a non-spermicide fit-free (60mm) diaphragm for a period of one year. They were advised to wear the diaphragm continuously, removing it once each day for washing but not within six hours after intercourse. Product-related problems related to insertion, retention and removal were few at both the 6- and 12-month follow-up visits, most commonly odor. The 12-month life table accidental pregnancy rate during typical use was 24.1 per 100 women (29.5 per 100 women without female barrier experience and 17.9 per 100 women with barrier experience). Over 85% of the women who returned for follow-up visits reported using the diaphragm during every act of intercourse. Until better data refute the traditional recommendations, users should be advised to add spermicide to fitted latex diaphragms.

Adult↗
PubMed1993

Internal medicine training in ambulatory gynecology. A house of staff survey.

OBJECTIVES: Practicing internists commonly provide gynecologic care, yet internists receive little formal training in ambulatory gynecology. To evaluate current residency training, we surveyed house staff perceptions of their training in gynecology. METHODS: Data were collected from house staff at five Portland, Ore, internal medicine training programs by questionnaire using a Likert scale about training in 24 gynecologic and five nongynecologic internal medicine problems. Responses were compared by level of training, institution, and gender. RESULTS: Responses were received from 195 (89%) of 221 residents. House staff reported less than adequate training in gynecology, particularly in the areas of family planning and medical complications of pregnancy, while reporting much superior training in the traditional medicine problems. CONCLUSIONS: House staff in internal medicine report little training in the diagnosis and treatment of gynecologic problems. Training in family planning may be particularly deficient. Residency programs must seek effective teaching strategies to address this deficiency.

Ambulatory Care↗
PubMed2006

Pharmacological treatment of Alzheimer's Disease.

BACKGROUND AND AIMS: The treatment of Alzheimer's disease (AD) is a challenge for physician, families, and patients. An individualized, multimodal treatment plan addressing the treatment of cognitive, behavioural and functional decline is essential. Aim of the paper is to describe the principal components of the treatment plan of AD patients. METHODS: A review of the recent literature was performed. RESULTS: Acetylcholinesterase inhibitors (AChEIs) play an important role in the improvement of cognitive decline in mild to moderate AD, even if the improvement is not permanent. Data obtained from the CRONOS project (involving about 500 Alzheimer Evaluation Units) replicate in the real world those obtained in controlled trials, confirming that AD patients may benefit from AChEI treatment. Treatment of behavioral and psychological symptoms of dementia (BPSD) requires education of caregivers, non pharmacological interventions, identification and treatment of medical illnesses or environmental precipitating conditions, specific pharmacological treatment. Traditional neuroleptics are widely used for BPSD treatment, but limited data support their use, and side-effects are frequent and severe. Atypical antipsychotics are effective in treating BPSD, and safer than traditional neuroleptics. However, the increased risk of cerebrovascular accident in patients taking risperidone or olanzapine limited currently their use in demented subjects. The use of antidepressant drugs, as well as behavioral approach, may improve depressive symptoms frequently accompanying AD. CONCLUSIONS: Although at present there is no cure for AD, several drug treatments and care strategies may improve or stabilize cognitive and behavioral symptoms, and improve the quality of life of patients and families.

Aged↗
PubMed2002

[Development of child mental health services in Lithuania: achievements and obstacles].

In 1990, political, economic and social changes in Lithuania introduced the possibility to develop for the first time in nations's history an effective and modern system of child mental health services. During the period between 1990 and 1995 a new model of services was developed in the Department of Social pediatrics and child psychiatry of Vilnius University. The model included development of child and adolescent psychiatric services, as well as early intervention services for infants and preschool children with developmental disabilities. The emphasis, following recommendations of WHO and existing international standards, was made on deinstitutionalization and development of family-oriented and community-based services, which have been ignored by previous system. In the first half of 90's of 20th century, new training programs for professionals were introduced, more than 50 methods of assessment, treatment and rehabilitation, new for Lithuanian clinical practice, were implemented, and a new model of services, including primary, secondary and tertiary level of prevention, was introduced in demonstration sites. However, during next phase of development, in 1997-2001, serious obstacles for replicating new approaches across the country, have been identified, which threatened successful implementation of the new model of services into everyday clinical practice. Analysis of obstacles, which are blocking development of new approaches in the field of child mental health, is presented in the article. The main obstacles, identified during analysis of socioeconomic context, planning and utilization of resources, running of the system of services and evaluation of outcomes, are as follows: lack of intersectorial cooperation between health, education and social welfare systems; strong tradition of discrimination of psychosocial interventions in funding schemes of health services; societal attitudes, which tend to discriminate and stigmatize marginal groups, including disabled children and dysfunctional families; lack of evidence-based decision making in the process of health care reform and reform of social infrastructure.

Age Factors↗
PubMed1991

A surface model approach to small area population estimation.

The author applies a surface model approach to the estimation of small-area population and household characteristics. "The representation of population-related information by means of surface concepts offers a way to overcome many of the limitations of traditional, 'fixed' zone-based methods. The approach has the potential to give planners and policy-makers greatly improved flexibility in handling and interpreting spatially referenced data. One practical area of application is the estimation of population at local levels for which the underlying concepts and methods are discussed in this article."

Demography↗
PubMed1983

Contraceptive failure and continuation among married women in the United States, 1970-75.

Using data from the National Survey of Family Growth (NSFG), this study reports differentials in contraceptive use-failure and continuation among married women aged 15-44 years in the United States. Failure rates differed by contraceptive intention. Within categories of intention, these rates differed by method, age, race, and parity. Users of modern methods had higher continuation rates than users of traditional methods. These results indicate that a woman's motivation is an important factor in long-term successful use of available contraceptive methods and that more effective and easier to use methods need to be developed.

Adolescent↗
PubMedDate not supplied

A call to action. Acculturation level and family-planning patterns of Hispanic immigrant women.

PURPOSE: To describe family-planning patterns of Hispanic women and to determine their relationship to acculturation level and to selected maternal demographic, pregnancy, and infant birth indices. DESIGN: Descriptive correlational. METHODS: A convenience sample of 376 Hispanic women was drawn from prenatal clinics in a large, public teaching hospital in the Southwest United States. Acculturation status was assessed during the prenatal period using the Acculturation Rating Scale for Mexican Americans II. Maternal data concerning pregnancy, infant birth, postpartum, and family planning were abstracted from the hospital record. Data were analyzed using descriptive, correlational, and multiple regression procedures. RESULTS: Most women were of Mexican origin, first generation in the United States, and oriented toward traditional Mexican cultural beliefs and values. Most were married, had less than an eighth-grade education, and experienced a first or second healthy pregnancy with healthy birth outcomes. Over 66% of the women returned for at least one visit in the first year postbirth; compliance at 1 yr declined to 28%. Five variables were significantly correlated with family-planning visit compliance: number of pregnancies, generation in the United States, acculturation level, trimester of first prenatal visit, number of prenatal visits, and gestational age of newborn. CLINICAL IMPLICATIONS: Nurses are in a pivotal position to educate the Mexican immigrant woman about healthcare for herself and for her family, but need to recognize cultural influences on family-planning behavior. Effective interventions build on existing knowledge, beliefs, and practices of traditional immigrant women. It is important to include the generation in the United States as an indicator of adherence to traditional values and beliefs.

Acculturation↗
PubMed1993

The demand for water in rural areas: determinants and policy implications.

Improving the adequacy and quality of water supplies is a priority for rural development in developing countries. So far, the strategies of governments and international donors for tackling the problem have been supply-driven; the fundamental importance of demand in the selection of appropriate policies has been virtually ignored. The realization that effective policy and planning must take into account what the rural clients want and are prepared to pay for was the impetus for the World Bank's multicountry study of households' demand for improved water services. This article summarizes the findings of the 1987-90 investigation of determinants of rural demand in selected regions of Latin America, Africa, and South Asia. The research team used both direct (contingent valuation) surveys and indirect (revealed preference) methods to estimate households willingness to pay for different levels and types of improvement. The methodology produced some illuminating insights into how to decide what level of service is appropriate for a particular community and how the improved services should be paid for. The team identified 4 broad categories of village situations, with appropriate policies ranging from the provision of house connections at full cost of one extreme, to no improvement in traditional supplies at the other extreme.

Conservation of Natural Resources↗
PubMed1996

Early results of user profiles: physicians' opinions on the use of information technology.

The role of physicians in today's managed care context is viewed as that of economic partner and clinical decision-maker, operating under the rules of professional autonomy and independence. To a considerable degree, physicians need to feel intrinsically motivated in order to change and adapt to new forms of health care delivery and information management. Today, health information managers use the rapid advances in telecommunications and computing technologies to plan and build vast health information networks, while at the same time receiving little support from systematic research to help understand, segment, and address the range of physicians' concerns and perceptions regarding these systems. This study's design employs a novel combination of qualitative and quantitative methods: first, to identify individual physician opinion profiles, and second, to group these profiles into clusters of similar perceptions. Opinions were obtained from primary care physicians in the Chicago area and resulted in four distinctly different profiles: Early Adopter, Traditional Family Doctor, Hesitant-Defensive Acceptor, and Unwilling-Uneasy Participant.

Adult↗
PubMed2001

Single room maternity care: the nursing response.

BACKGROUND: The introduction of single room maternity care in the 1990s necessitated a new approach to nursing education and practice. A focus on perinatal nursing requires competence across the spectrum of labor, delivery, postpartum and newborn care. We sought to evaluate the nursing response to this change by comparing satisfaction with the workplace environment among single room maternity care nurses before and after they worked in the setting and among nurses working in traditional birth settings. METHODS: Six months before the opening of a pilot seven-bed single room maternity care unit, nurses who planned to work in the new unit completed a survey about their satisfaction with aspects of their work environment. Three months after the new unit opened the survey was repeated with this study group and also by a sample of nurses working in the delivery and postpartum areas. RESULTS: Responses indicated that single room maternity care nurses before and after working in the unit were significantly more satisfied with the physical setting, their ability to respond to patients' needs, their opportunity for teaching families, the nursing practice environment, peer support, and their perceived level of competency. They rated their satisfaction significantly higher than that of their colleagues in the traditional delivery and postpartum settings. CONCLUSIONS: The positive transition to single room maternity care by obstetrical nurses was demonstrated by their improved overall satisfaction with the work environment. Evaluation of the nurses' responses to changes in health care delivery has important implications for justifying new clinical approaches and planning for future changes.

Adult↗
PubMed2002

Decoding cis-regulatory DNAs in the Drosophila genome.

Cis-regulatory DNAs control the timing and sites of gene expression during metazoan development. Changes in gene expression are responsible for the morphological diversification of metazoan body plans. However, traditional methods for the identification and characterization of cis-regulatory DNAs are tedious. During the past year, computational methods have been used to identify novel cis-DNAs within the entire Drosophila genome. These methods change the way that cis-DNAs will be analyzed in future studies and offer the promise of unraveling complex gene networks.

Animals↗
PubMed2003

Perception of efficacy and safety as determinants for use and discontinuation of birth control methods in Muslim Jordanian women.

OBJECTIVE: This study was conducted to identify the perceptions of working Muslim Jordanian women regarding the efficacy and safety of their contraceptive methods, and whether these perceptions affected method choice or discontinuation. METHODS: A prospective study on 207 married working women of reproductive age was conducted between March and June 2002. RESULTS: The majority of women were using an intrauterine device (IUD), fewer were using traditional methods and oral contraceptive pills. Effectiveness was the main reason for choosing IUD and pill methods, while concerns about safety were the main reason for discontinuation. Safety was the main reason for choosing traditional methods and poor efficacy was the reason for discontinuation. CONCLUSION: Health-care professionals need to increase the use of proper contraceptive methods and compliance by providing counseling services and correcting any misperceptions regarding birth control methods before and during use.

Adult↗
PubMed2000

A brief smoking cessation intervention for women in low-income planned parenthood clinics.

OBJECTIVES: The purpose of this study was to evaluate a brief smoking cessation intervention for women 15 to 35 years of age attending Planned Parenthood clinics. METHODS: Female smokers (n = 1154) were randomly assigned either to advice only or to a brief intervention that involved a 9-minute video, 12 to 15 minutes of behavioral counseling, clinician advice to quit, and follow-up telephone calls. RESULTS: Seventy-six percent of those eligible participated. Results revealed a clear, short-term intervention effect at the 6-week follow-up (7-day self-reported abstinence: 10.2% vs 6.9% for advice only, P < .05) and a more ambiguous effect at 6 months (30-day biochemically validated abstinence: 6.4% vs 3.8%, NS). CONCLUSIONS: This brief, clinic-based intervention appears to be effective in reaching and enhancing cessation among female smokers, a traditionally underserved population.

Adolescent↗
PubMed2003

[Clinical psychophysiology in the primary care system].

In the beginning of the 21st century, a need for a different medical approach arises among the medical systems in the world. This new attitude, beyond laboratory tests, imaging procedures, and pharmacological treatment, emphasizes the significance of the role of the patient, and transfers the control to the patient himself and his/her family. This is the biopsychosocial medical approach. In such a system the medical staff considers not only the traditional biological factors, but also the mental and environmental factors, when it plans the treatment course. The lack of consideration of the real medical and psychological needs of the patient can result in misuse of essential resources. It can also lead to the frustration of the patient and the medical personnel. Clinical psychophysiology is a treatment implementation of the biopsychosocial approach, and it is supposed to meet the biological and psychological needs of the patient. The biopsychosocial method integrates physiological treatments and behavior-cognitive care. The article describes in detail various processes of the clinical psychophysiology, according to the current professional literature. We conclude that the clinical psychophysiology might be useful in treating many problems in primary medicine, such as chronic pain, hypertension, sleep disturbances, and attention disorders. The primary care system is the optimal place to practice the biopsychosocial method, and the challenge is to develop the appropriate doctrines, which would enable the medical staff to help the patients in need. In the article we discuss in details five strategies which allow broader use of the instruments of the clinical psychophysiology: 1) Expansion of doctors education; 2) Allied health professionals involvement; 3) Integration of behavioral medical treatment in primary care; 4) Causing effective modification with minimal medical staff contiguity; 5) Referral for follow-up treatment. The clinical psychophysiology, in the framework of primary care, is a powerful integration of the biomedical and bio-social models.

Delivery of Health Care↗
PubMedDate not supplied

The impact of recent policy changes on fertility, abortion, and contraceptive use in Romania.

A national household survey of 4,861 women aged 15-44 on reproductive health issues was conducted in Romania in 1993. The survey provided the opportunity to study the impact of policy changes by comparing selected aspects of fertility, abortion, and contraceptive use before and after the December 1989 revolution, when the laws restricting abortion and contraceptive use were abolished. After abortion became legal, the total fertility rate dropped to below replacement level, while the induced abortion rate doubled. Contraceptive prevalence increased 20 percent, but augmentation of the use of traditional methods, rather than the change in legislation, accounted for 70 percent of the increase. Limited sex education and contraceptive information, mistrust and misinformation about modern methods, a lack of adequately trained providers, and a shortage or uneven distribution of contraceptive supplies are major reasons for the continued high rates of unintended pregnancy.

Abortion, Induced↗
PubMed1984

A comparison of three social-psychological models of attitude and behavioral plan: prediction of contraceptive behavior.

We compared the predictive validities of three prominent models of attitudes and behavioral decisions: Rosenberg's instrumentality-value model, Fishbein's belief-evaluation model, and Beach's adaptation of subjective expected utility theory. Seventy female undergraduates rated each of the models' components and reported their attitudes and behavioral plans toward using three different methods of contraception. With the traditional across-subjects prediction procedure, the Rosenberg model generally accounted for 5-25% less variance in subjects' attitudes and behavioral plans than the Fishbein an Beach models, which were not different. With a within-subject prediction procedure, the Rosenberg model was again the least accurate, and the Fishbein and Beach models had similar predictive accuracy. As hypothesized, within-subject predictions were more accurate than across-subjects predictions. The relatively poor performance of the Rosenberg model was attributable to the instrumentality component. In addition, we found that the Beach model could be simplified with no appreciable loss in predictive accuracy. Finally, a subject's personal normative beliefs emerged as a strong independent predictor of behavioral plan.

Adult↗