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Issues for South Asian Indian patients surrounding sexuality, fertility, and childbirth in the US health care system.

BACKGROUND: In 1998 ethnic minorities comprised 28% of the US population, and India is the third most common country of origin for immigrants. Many recently immigrated South Asian Indian patients are seen in health care settings in the United States. To deliver health care effectively to these patients, it is helpful for physicians to understand common cultural beliefs and practices of South Asian Indian patients. METHODS: Two illustrative cases are reported. One author's observations of the care of pregnant and parturient women in India and similar experiences in our own office spurred a literature search of the cultural behaviors surrounding sexuality, fertility, and childbirth. A literature search was conducted in Index Medicus, Grateful Med, and the catalogue of the University of Pennsylvania Arts and Sciences library, using the terms "Indian," "South Asian," "male and female gender roles," "gynecology in third world," "sexuality," "sexual health," "women's health," "women's health education," "obstetrical practices/India," and "female roles/India." RESULTS: Issues surrounding sexuality and childbirth that arise during the US physician-South Asian Indian patient encounter might not correspond to the commonly held knowledge, beliefs, and behaviors of the US health care system. Common cultural beliefs and behaviors of South Asian Indian patients around sexuality and childbirth experience include the role of the individual patient's duty to society, the patient's sense of place in society, lack of formal sexual education, prearranged marriages, importance of the birth of the first child, little premarital contraceptive education, dominance of the husband in contraceptive decisions, and predominant role of women and lack of role for men (including the husband) in the childbirth process. CONCLUSION: Lack of understanding of the Indian cultural mores surrounding sexual education, sexual behavior, and the childbirth experiences can form barriers to Indian immigrants in need of health care. These misunderstandings can also lead to patient dissatisfaction with the health provider and health system, underutilization of health services, and poorer health outcomes for Indian immigrants and their families. For this reason, it is important to teach cultural issues during undergraduate, graduate, and continuing medical education.

Adult↗

Information needs of naval primary care providers and patients at sea.

OBJECTIVE: To optimally practice medicine, and to live healthy lives, providers and patients need convenient access to authoritative information. The goal of this study was to determine the information needs of naval primary care providers and patients at sea to aid development of a digital health sciences library for naval primary care providers and patients. METHOD: A literature-based needs assessment was conducted from articles identified using MEDLINE searching and U.S. Navy health care information sources. Recurring medical problems/diseases/topics were identified and categorized. RESULTS: Eighty-one articles and books were reviewed and abstracted, representing a broad base of naval medicine. Twenty-one medical and surgical theme areas and 125 medical problems/diseases/topics were recurrently identified. CONCLUSIONS: The common naval medical problems identified are nearly identical to the common medical problems in the general population, have changed little from the 18th century, and were consistent with first-hand information from naval primary care providers.

Databases, Factual↗

A unique approach to multi-state networking: BHSL (Basic Health Sciences Network).

Development of a reciprocal multi-state shared resources network is described. The Basic Health Sciences Library Network (BHSL) is one the largest interlibrary loan networks free of direct charges to participants and any direct federal or state funding. Established in June 1986, BHSL started with 132 member libraries from three northeastern states. Current membership is 460 libraries in 10 states. Interlibrary loan activity for 1992 resulted in a collective cost savings of $592,672. This model of resource sharing can be applied to any group of libraries that access a common locator tool.

Cost Savings↗

LATCH -- it works!

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Libraries, Hospital↗

Health information outreach: the land-grant mission.

Service to the state is one of the core principles of the land-grant mission. This concept of service is also fundamental to a significant number of outreach activities in academic health sciences libraries, particularly those libraries affiliated with the public land-grant universities. The Dana Medical Library at the University of Vermont has a lengthy tradition of outreach to health care providers and health care consumers of the State of Vermont. Building on the foundation of the land-grant institution-which grew out of federal legislation introduced in the mid nineteenth century by Justin Morrill, Vermont's congressional representative--the Dana Medical Library has based its outreach activities on its dedication of service to the state in the promotion of healthy citizens through information dissemination in support of health care delivery. Reengineering library services designed to meet the specific information needs of its diverse clientele, partnering with disparate health care organizations, and relying on fees for service to expand its outreach activities, the Dana Medical Library has redefined the concept of health information outreach for the new millennium.

History, 19th Century↗

Using a journal availability study to improve access.

PURPOSE: Identify journal collection access and use factors. SETTING AND SUBJECTS: University of North Carolina at Chapel Hill's Health Sciences Library patrons. METHODOLOGY: Survey forms and user interactions were monitored once a week for twelve weeks during the fall 1997 semester. The project was based on a 1989 New Mexico State University study and used Kantor's Branching Analysis to measure responses. RESULT: 80% of reported sought journal articles were found successfully. Along with journal usage data, the library obtained demographic and behavioral information. DISCUSSION AND CONCLUSIONS: Journals are the library's most used resource and, even as more electronic journals are offered, print journals continue to make up the majority of the collection. Several factors highlighted the need to study journal availability. User groups indicated that finding journals was problematic, and internal statistics showed people requesting interlibrary loans for owned items. The study looked at success rates, time, and ease of finding journals. A variety of reasons contributed to not finding journals. While overall user reports indicated relatively high success rate and satisfaction, there were problems to be addressed. As the library proceeds in redesigning both the physical space and electronic presence, the collected data have provided valuable direction.

Academic Medical Centers↗

Hospital librarianship in the United States: at the crossroads.

This paper examines recent developments in hospital librarianship in the United States, including the current status of hospital-based clinical library services. Several examples of hospital library services are presented that demonstrate some characteristics of struggling and thriving services. The implications of the informationist concept are considered. The continuation of the hospital librarian's primary role in support of patient care is explored, as core competencies are reexamined for relevancy in the new millennium.

Ethics, Professional↗

Designing a curriculum on Internet health resources for deaf high school students.

PURPOSE: This paper examines the integration of instruction about quality health resources on the Internet into the health curriculum of a specialized high school for students with hearing disabilities. SETTING/PARTICIPANTS/RESOURCES: The Health Sciences Library System (HSLS) at the University of Pittsburgh has formed a partnership with the Western Pennsylvania School for the Deaf (WPSD). BRIEF DESCRIPTION: This project was partially funded through a subcontract with the National Library of Medicine. As one component of its Health Information for the Public project, HSLS formed a partnership with the WPSD. This partnership allowed for a librarian to provide instruction to health education and learning center teachers and students at WPSD about health resources on the Internet. This paper describes the planning process, curriculum development, and challenges encountered. These challenges include student knowledge of English as a second language, the need for a sign language interpreter, students' third-to-fourth-grade reading levels, and the need for appropriate visual presentations to accompany the audio counterpart. RESULTS/OUTCOME: The partnership formed between HSLS and WPSD improved deaf high school students' ability to locate quality health information on the Internet. EVALUATION METHOD: A pre-class survey and post-class survey were used to determine the impact of the instruction.

Adolescent↗