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PubMed1979

Psychologic effects of vasectomy in voluntarily childless men.

Forty-four childless men and 51 vasectomized parents were compared as to their childhood backgrounds, marital satisfaction, social/emotional adjustment, physical and emotional problems attributed to the vasectomy, and attitudes toward vasectomy as a means of birth control. The findings suggested that for young married men, firmly committed to childlessness and in agreement with their wives regarding the necessity of the operation, vasectomy appears to be as physically and psychologically safe as in married parents for at least a two-year period. There were differences in the childfree men and fathers in styles of adjustment, with the childfree reporting themselves to be more independent, mobile, and less tied to tradition; these differences were seen as being more related to choosing a childfree life style than to the choice of vasectomy as a contraceptive method.

Adult↗
PubMed2004

Screening family planning needs: an operations research project in Guatemala.

BACKGROUND: Public sector health care providers in rural Guatemala have infrequently offered family planning information and services in routine visits. This operations research project tested a strategy to modify certain practices that prevent health workers from proactively screening clients' needs and meeting them. METHODS: The research design was quasi-experimental with a pretest-posttest-follow-up comparison group design. Health districts, which comprise health centers and posts, were purposively assigned to intervention or comparison groups to assure comparability of the two groups. The strategy was based on a job-aid designed to guide health workers in screening clients' reproductive intentions and family planning needs, help them to offer contraceptive methods if the woman expressed interest, and facilitate the provision of the method chosen at the time of the visit. The strategy was implemented at intervention sites during a period of six months. Upon completion of post-intervention measurements, the strategy was scaled up to the comparison sites, and a follow-up assessment was conducted nine months later. Results were evaluated by conducting three rounds of exit interviews with women exposed to the risk of unwanted pregnancy. RESULTS: Study results showed a two to five-fold increase in providers' screening of clients' reproductive intentions. The proportion of clients who received information about contraceptives increased from 8% at the baseline to 42% immediately post-intervention, and 36% at the follow-up survey. The intervention also proved successful in improving the role service providers play in offering women a chance to ask questions and assisting women in making a selection. The proportion of women who received a method, referral or appointment increased and remained high in the intervention group, although no change was seen in the comparison group after their participation in the strategy. CONCLUSION: The easy-to-use job aid developed for this project proved useful for screening clients' needs and reducing providers' reluctance to discuss family planning with clients and offer contraceptive services. Such family planning screening devices can be useful in traditional settings where both providers and clients shy away from discussing family planning issues.

Journal Article↗
PubMed2000

Rehab rounds: overcoming barriers to individualized psychosocial rehabilitation in an acute treatment unit of a state hospital.

Psychiatric rehabilitation begins during the acute stages of a psychiatric disorder and continues throughout the person's lifetime, with the types of services flexibly keyed to the person's phase of illness, needs, and personal goals. During periods of relapse and exacerbation of symptoms, when hospitalization is often required, psychiatric rehabilitation should include the following five objectives: * Clarify how the person's own goals in life, such as a desire for more self-control, freedom of choice, privacy, and time with friends and family, can be served by inpatient treatment and symptom stabilization. * Educate the patient about the nature of his or her illness and how medications work to restore self-control. * Teach the patient about side effects and self-monitoring and negotiating about medication and its effects in a collaborative way with the psychiatrist and other members of the treatment team. * Connect with the family or other natural supports that the person has in the community. * Enable the patient to make appropriate aftercare plans for residential and continuing treatment needs after discharge. When rehabilitation is viewed from the vantage point of these objectives, the inextricable interweaving of "treatment" with "rehabilitation" becomes clear. Treatment and rehabilitation are two sides of the same. It is much easier to integrate psychiatric rehabilitation into more traditional methods of treatment than it is to reorganize a treatment program or facility so that it blends rehabilitation with prevailing treatment imperatives of pharmacotherapy, supervision, and security and safety. In previous Rehab Rounds columns, we have described examples of creative methods for bringing the principles and practices of psychiatric rehabilitation into the treatment milieu (1,2,3). Faced with regulatory criticism from governmental agencies, Dr. Dhillon and his colleagues at Eastern State Hospital in Williamsburg, Virginia, launched a vigorous initiative to bring psychiatric rehabilitation into the forefront of their clinical enterprise. To enable readers to learn from their successful experience and adapt some of the administrative and clinical procedures that worked in Virginia, Dr. Dhillon and Ms. Dollieslager describe the operational details of their odyssey. We believe that their effectiveness in changing a traditional institution can be duplicated in many other places-in units within general hospitals or other community-based settings-as well as in state psychiatric hospitals, where acute treatment has been limited to pharmacotherapy and recreational and diversional activities.

Acute Disease↗
PubMed1997

Umbanda healers as effective AIDS educators: case-control study in Brazilian urban slums (favelas).

During a 12-month period (November 1994-October 1995), Afro-Brazilian Umbanda healers (Pais-de-Santo) taught 126 fellow healers from 51 Umbanda centres (terreiros) located in seven overcrowded slums (favelas) (population 104-343) in Brazil's northeast, the biomedical prevention of AIDS, including safe sex practices, avoidance of ritual blood behaviours and sterilization of cutting instruments. A face-to-face educational intervention by healers, marginalized in society yet respected by devotees, which blended traditional healing-its language, codes, symbols and images- and scientific medicine and addressed social injustices and discrimination was utilized in this project supported by the Brazilian Ministry of Health, National Program in STDs/AIDS. Significant increases (P < 0.001) in AIDS awareness, knowledge about risky HIV behaviour, information about correct condom use, and acceptance of lower-risk, alternative ritual blood practices and decreases (P < 0.001) in prejudicial attitudes related to HIV transmission were found among mobilized healers as compared to 100 untrained controls. Respected Afro-Brazilian Pais-de-Santo can be creative and effective partners in national HIV prevention programmes when they are equipped with biomedical information about AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Family planning in the Jewish population of Israel: correlates of withdrawal use.

This report describes trends and differentials in contraceptive practices among Israeli Jews. Data from two fertility surveys show a heavy reliance on the IUD, little use of sterilization, and declining, but still significant use of withdrawal. The factors associated with the practice of withdrawal are explored. Evidence is found in support of Santow's hypotheses that the degree of sex-role differentiation within marriage and the belief that men hold the authority in reproductive decisionmaking are both positively related to the practice of withdrawal. Fear of oral contraceptives, a dislike of sterilization, and a reliance on the IUD only at greater parities imply a continuing role for withdrawal, especially among Israeli Jewish couples in which wives are less educated and have more traditional sex roles than the wives in other couples.

Adult↗
PubMed2004

Mental health promotion in post-conflict countries.

Meeting the mental health needs of those persons in conflict and post-conflict situations in the eastern Mediterranean region (EMR) is an important goal of the World Health Organization. Of the 22 countries in the EMR, 85% of the population has been affected by conflict in the past two decades. This has resulted in a high prevalence of mental disorder, most commonly depression, post-traumatic stress disorder and anxiety. A number of innovative, culturally sensitive interventions have been developed to meet the mental health needs of the populations. These include the use of 'focusing' in Afghanistan, the Education for Peace Programme in Lebanon, the United Nations Relief and Works Agency's work with refugees in Gaza, life skills education in Iran and the training of professionals in Afghanistan. In post-conflict situations there are six levels of interventions needed: first, increasing resilience; second, making the family the focus for effective support; third, encouraging community solidarity and traditional methods of support: fourth, using the media in mental health promotion; fifth, the integration of mental health skills of caring for the population with general services; and sixth, focusing on long- rather than short-term measures.

Health Planning↗
PubMed2002

Health promotion and participatory action research with South Asian women.

PURPOSE: To examine South Asian immigrant women's health promotion issues and to facilitate the creation of emancipatory knowledge and self-understanding regarding health-promoting practices; to promote health education and mobilization for culturally relevant action. METHOD: The study was based on critical social theory; the research model was participatory action research (PAR). Two groups of South Asian women (women from India and of Indian origin) who had immigrated to Canada participated in the project. The qualitative data were generated through focus groups. Reflexive and dialectical critique were used as methods of analyzing qualitative data. The data were interpreted through reiterative process, and dominant themes were identified. FINDINGS: Three themes that were extracted from the data were: (a) the importance of maintaining culture and tradition, (b) placing family needs before self, and (c) surviving by being strong. An issue for action was the risk of intergenerational conflicts leading to alienation of family members. Over a period of 3 years, the following action plans were carried out: (a) workshops for parents and children, (b) sharing of project findings with the community, and (c) a presentation at an annual public health conference. CONCLUSIONS AND IMPLICATIONS: The project activities empowered participants to create and share knowledge, which was then applied toward action for change. Health and health promotion were viewed as functions of the women's relationships to the world around them.

Community Participation↗
PubMed1991

Evaluating family-centered programs in neonatal intensive care.

With the passage of P.L. 99-457 in October of 1986, the field of early intervention has been faced with the challenge of broadening its scope (Silber, 1989). This legislation expanded early intervention from a child-centered service to a service offered to families within a variety of contexts; from a service for children with special needs to a service available to families as soon as risks are identified. New programs are being designed and developed with an interagency focus which serve not only children with developmental disabilities but also their families in health, education and social services (Cornwell and Thurman, 1990). Current legislation suggests that services should be available to families as soon as their children are identified as being at-risk (Smith, 1987). In response to the legislation, states are developing definitions of "at-risk" based on criteria other than the child's test scores. Therefore, in many cases, early intervention services are being offered to families while their at-risk infants are still hospitalized and receiving intensive care. Evaluation of these innovative and complex service delivery programs is being addressed as these services are developed. With the broadening of the scope of early intervention comes the need to rethink the traditional methods of evaluating these programs. This paper will address some of the issues involved in evaluating family-centered programs which are based in neonatal intensive care units (NICU).

Child, Hospitalized↗
PubMed1989

Sociodemographic determinants of contraceptive method choice in Sri Lanka: 1975-82.

The determinants of contraceptive method choice in Sri Lanka are examined during a period in which contraceptive prevalence increased by over 60% and involved substantial use of sterilization and traditional methods. Data are from the 1975 World Fertility and 1982 Contraceptive Prevalence Surveys. Polytomous logistic regression is used to model four current contraceptive choices: non-use, use of a traditional method, use of a modern temporary method and use of sterilization. The analysis shows, in 1975 and 1982, strong socioeconomic as well as demographic effects on whether any method is used. However, in both years the type of method chosen is primarily a function of demographic considerations related to the couple's family-building stage rather than social status, implying that in Sri Lanka there are few socioeconomic barriers limiting access to different contraceptive methods. The family planning programme, however, has emphasized sterilization rather than birth spacing methods.

Age Factors↗
PubMed1996

Barriers to contraceptive use in Kenya.

This study was designed to identify and to better understand the barriers to contraceptive use among Kenyan-couples. Data were collected through structured interviews and focus group discussions among couples not planning for pregnancy and not using any effective contraceptive method. The study was conducted in the Baba Dogo urban slum area of Nairobi, and Chwele, a rural sub-location in Bungoma, western Kenya. Some important barriers to contraceptive use were identified in couples wishing to space or limit further births. Those barriers included lack of agreement on contraceptive use and on reproductive intentions; husband's attitude on his role as a decision maker; perceived undesirable side effects, distribution and infant mortality; negative traditional practices and desires such as naming relatives, and preference for sons as security in old age. There were also gaps in knowledge on contraceptive methods, fears, rumours and misconceptions about specific methods and unavailability or poor quality of services in the areas studied. This paper recommends that information and educational programmes should be instituted to increase contraceptive knowledge, to emphasise the value of quality of life over traditional reproductive practices and desires, and to improve availability and quality of services.

Adolescent↗
PubMed2005

Opinion of newly wed Greek couples about the nature and functions of modern family. Similarities and differences with the opinion of Bulgarian couples.

BACKGROUND: Among the European countries, Greece has exhibited a significant decline in its total fertility rate. Unlike Bulgaria, Greece conducts little in-depth research to study comprehensively the attitudes of newlywed couples toward family planning and reproductive behaviour. AIM: The present study aimed at exploring the opinion of newly married Greek couples about the nature and functions of modern family and comparing them with those of Bulgarian couples. MATERIAL AND METHODS: We conducted two parallel cross-sectional studies gathering the primary data by individual questionnaire survey using established methods. RESULTS: More than half of the respondents planned to have a child within two years after marriage. Most of the respondents think that the main purpose of having children in a family is to give meaning to a person's life. In both Greece and Bulgaria giving birth to a child in a family is believed to be the consequence of merely life-experience related and emotional prerequisites that arise from the deeply rooted traditional attitudes in these countries towards the value and role of family. The prevailing opinion is that children should be raised by the parents in their parents' home until they become three years of age. Greek women are more inclined than Bulgarian women to stay at home and raise their children even until they complete school and are ready to care for them after graduation and marriage.

Adult↗
PubMedDate not supplied

Mainstreaming contraceptive services in managed care--five states' experiences.

CONTEXT: The ongoing, rapid national transition from a health care financing and delivery system dominated by traditional indemnity insurance to one dominated by managed care has enormous implications for the accessibility of contraceptive services. METHODS: In each of five areas with relatively mature managed care environments (all of Colorado, Massachusetts and Michigan, as well as selected counties in California and Florida), all managed care organizations serving commercial or Medicaid enrollees were asked about their coverage of contraceptive services and the procedures for obtaining that care. In addition, all publicly funded family planning agencies in these areas were queried about their involvement with managed care plans, and representative samples of reproductive-age women at risk of unintended pregnancy and enrolled in managed care plans were asked about their plan's coverage and their experiences in obtaining contraceptive services. RESULTS: Fifteen percent of health maintenance organizations and point-of-service plans did not cover all five of the most commonly used medical contraceptive methods, and another 6% covered none of the methods. Only half the plans informed enrollees--and even fewer informed enrollees insured indirectly as dependents--of whether they covered contraceptive services. One in four women in commercial plans were unsure whether their plan covered oral contraceptives, and two in three did not know if their plan covered the other medical methods. Only one in four commercial plans have brought community-based family planning providers into their networks, and more than half of all publicly funded family planning agencies reported having no contracts with managed care organizations. Finally, nearly one in three women in managed care plans reported difficulties in obtaining contraceptive services, with 13% of enrollees in commercial plans waiting at least four weeks for an appointment for contraceptive care. CONCLUSIONS: To adequately address the contraceptive needs of their employees, employers must ensure that the health insurance plans they purchase provide adequate coverage of contraceptive methods. For their part, managed care organizations and state Medicaid programs should examine their policies and procedures to ensure that services are easily accessible to women needing contraceptive care.

Adolescent↗
PubMed1988

Survey report: Senegal.

Senegal, situated on the west coast of Africa, has a history of high fertility and high infant mortality. Preliminary results of the 1986 Demographic and Health Survey (DHS), administered by the Institute for Resource Development, Columbia, Md., indicate a slight decline in the birth rate and reveal a high prevalence of child health problems associated with poor sanitation and nutrition. Senegal's 7.1 million people (1987 estimate) are unevenly distributed throughout the country's dry, flat landscape. Some 40% of the population is urban, and about 1/2 of these urban residents live in the capital, Dakar. Heavy rural-to-urban migration has been encouraged by the high population growth rate--2.8% annually--and a poor standard of living in the countryside. With about 70% of the labor force dependent on agriculture, a drought-related drop in the yields of groundnuts and other cash crops contributed to the rural exodus and to growing unemployment in the capital. The 1986 survey of family planning and child health collected information from 4415 women 15-49 years of age, and measured the height and weight of their children between 6 and 36 months. The findings suggest that fertility may have fallen slightly since 1978. The Senegal DHS recorded a total fertility rate (TFR) of 6.5 average births/woman during the 1981 Senegal World Fertility Survey (WFS). The DHS also found that women at the end of their childbearing--age 45-49 in 1986--had borne 7.4 children on average, further evidence of a slight decline in births among the younger women. Senegalese women marry young. The average age at 1st marriage is only 16.1, according to the 1986 DHS, and family planning within marriage is not widely accepted. In 1986, 11.7% of the currently married women 15-49 used some form of birth control, but only 2.7% used a modern method. While this is a large increase over the 3.9% rate of contraceptive use recorded in the 1978 WFS, almost 3/4 of the gain was due to a higher reported use of abstinence and withdrawal. In fact, 29% of the married women had relied on abstinence some time in the past, while only 6% had ever used a modern method. Current use of the pill and the IUD increased 4-fold between 1978 and 1986, but the 1986 level is still too low to have much effect on fertility rates. The knowledge of various contraceptive methods did increase significantly between 1978 and 1986. For example, only 18% of the married women said they were familiar with the pill in 1978, while 51% knew about it in 1986. In general, knowledge of modern contraceptives grew from 20%-68% of married women, while knowledge of traditional methods increased from 50-90%., between 1978 and 1986. When asked why they did not use contraceptives, 34% of the women said they were trying to become pregnant, and 19% said religious proscriptions against birth control discouraged them from using contraceptives. The preliminary DHS report also showed that 43% of the children under age 5 had vaccination cards, according to their mothers, although interviewers were able to verify the existence of cards for only 23% of the children. Up to 77% of the children under age 5 living in the Dakar region had vaccination cards (46% verified by interviewers), in marked contrast to the rest of the country.

Africa↗
PubMed2006

Hereditary gingival fibromatosis: aggressive 2-stage surgical resection in lieu of traditional therapy.

INTRODUCTION: Hereditary gingival fibromatosis (HGF) is a rare condition characterized by progressive enlargement of the gingiva. Most cases follow autosomal dominant genetics, with a reported incidence of 1 in 750,000. In addition to cosmetic concerns, the compromised oral cavity may cause difficulty with eating, speech, hygiene, and oral competence. In addition, social consequences can be dramatic, forcing patients to lead isolated, reclusive lives. Traditional therapy uses serial gingival resections ("quadrantectomies") with primary closure. However, this method is associated with frequent recurrence and additional resections. We report on a family of 12 siblings, 8 of whom, including monozygotic twins, are affected with HGF. We describe corrective surgery for 3 siblings, as well as their long-term follow-up. METHODS: Three sisters suffered from severe maxillary and mandibular gingival hyperplasia. All complained similarly of weight loss, difficulty with articulation, and social isolation. Physical examination revealed massive overgrowth of both maxillary and mandibular gingiva, as well as multiple ectopic teeth. Following diagnostic biopsy, all 3 patients underwent staged resections. The first stage involved resection of the maxillary component, followed by a planned second-stage resection of the mandibular component. All resections included gingivectomies, odontectomies, and alveolar ridge ostectomies. The oral cavity was allowed to heal by secondary intention. RESULTS: All 3 patients were female, and ages ranged from 34-48 years (mean: 43). Follow-up on the 3 patients ranged from 3-18 months (mean: 11 months). There has been no evidence of recurrence to date. The gingiva remucosalized uneventfully within several weeks, and all patients are tolerating solid food. All patients report dramatically improved speech, oral hygiene, and self-confidence. CONCLUSIONS: In an effort to address the high recurrence rate, we describe our aggressive surgical approach, including resection of the hypertrophied gingiva and alveolar processes. Two-staged gingival resection, as opposed to the more traditional 4-stage quadrantectomy approach, has resulted in no recurrence to date, suggesting an improved outcome over the traditional techniques.

Adult↗
PubMed2001

Dermatoscopic screening in family practice.

BACKGROUND: Screening for dermatologic lesions is important in primary care medicine and may be enhanced by magnified illuminated video images. Viewing skin lesions with a dermatoscopic instrument is very helpful in judging and evaluating their characteristics. Both patients and physicians benefit from the improved diagnostic yield, possible medical-legal protection, enhanced development of the patient-physician relationship, medical practice economic boost, and more efficient dermatologic screening. The higher magnification and illuminated view theoretically enables the physician to make better decisions and helps convince the patient to comply with recommended treatment. METHODS: 57 patients in a single private family practice were interviewed before receiving a visual dermatology screening examination. The physician then recorded his findings and suggested plan. Next, the physician performed a magnified video dermatologic examination and once again recorded his findings, plan, and impression of the patient's reaction to the recommendations and treatment. RESULTS: 57 patients with 79 examination sites demonstrated an increased confidence by both the physician and patient with the video examination over the traditional dermatologic examination. In addition, several changes in proposed treatment were noted following the video examination. CONCLUSIONS: Both the patients and physician believed the magnified video dermatologic examination improved diagnostic accuracy and increased patient motivation to act on physician recommendations.

Family Practice↗
PubMed2002

Mother and child health care in Kabul, Afghanistan with focus on the mother: women's own perspective.

BACKGROUND: The study examined the pattern of utilization of Maternal and Child Health (MCH)-services of women with child-bearing experience in a suburb of city Kabul. METHODS: A semi-structured questionnaire administered to 100 women in the community and 40 in the maternal hospital. Interviews and observations in the local MCH-clinic were used to collect the relevant information. RESULTS: Sixty one of the 100 women in the community delivered at home exclusively, 35 having experienced both home and institutional deliveries, four women had hospital childbirths only. Approximately half of the women decided about utilizing the modern MCH services themselves. Women valued in the MCH-clinic mainly medical care and vaccinations. Delivery was seen primarily as a technical event, but when probed more deeply it was obvious, that fear of death was the driving power for decisions made. With at-home deliveries female relatives were preferred as birth assistants. If outside assistance was required, trained midwives were preferred rather than traditional birth attendants. Institutional delivery was seen as the last resource for complicated deliveries, but was also esteemed by many because of the security and cleaness. Professional skill, but also empathy and justice were appreciated in professionals. CONCLUSIONS: Promoting rooming-in and early breast feeding in the maternity wards, ongoing education of the MCH-staff about communication skills, ethics and teaching methods, dialogue with decision makers on all levels in the society about MCH including family planning, ongoing training and support of community midwives (dayas) in the community by local MCH-staff, adequate supplies, inexpensive services, incentive money for the competent staff members are recommended.

Adolescent↗
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↗