Rockett, L R
The law governing confidentiality and informed consent has acquired unique characteristics in the area of reproductive health, as a consequence of both the establishment of a constitutional right to privacy in reproductive health matters and the reaction of those politically and morally opposed to the exercise of that right. The primary issues have involved: 1) the right of minors to receive reproductive health services without parental consent, which remains a political battleground; 2) laws requiring physicians to provide information to pregnant patients that is intended, not to inform them of the risks and benefits of the procedure, but to discourage them from obtaining abortions; 3) coerced and prohibited sterilizations; 4) court-ordered contraception and procedures to protect the fetus; and 5) restrictions on counseling about abortion, contraception, sterilization, and other reproductive health services authorized by state conscience or noncompliance clauses that shield such restrictions from the usual ethical, medical, and legal rules governing informed consent. The last area is of profound significance to the ability of women to make informed decisions about their reproductive health options. In the current economic environment, which fuels mergers and acquisitions involving sectarian and nonsectarian institutions, women are increasingly being put at risk as a result of such restrictions.
The contemporary legal and policy environment has increased the challenges associated with providing health care services to the adolescent population. The issue of reproductive health care services is particularly intense because of the controversial nature of services for contraception and abortion. As the debates continue, one must remember the background against which they are occurring. The current legal framework, developed over nearly 40 years, enables adolescents who are minors to give their own consent for care in numerous circumstances and provides them with a significant level of confidentiality protection, particularly for reproductive health services. Laws have been enacted to expand adolescents' financial access to health care, through targeted publicly funded service programs and expanded health insurance coverage. This background provides the foundation for addressing the current challenges and for protecting and expanding adolescents' access to care.
Matejić, Bojana; Kesić, Vesna
The ethics of reproductive health covers a wide field of different issues, from the ethical dimensions of assisted reproduction, life of newborns with disabilities to the never-ending debate on the ethical aspects of abortion. Furthermore, increasing attention is paid to the ethical dimensions of using stem cells taken from human embryos, the creation of cloned embryos of patients for possible self-healing, and the increasingly present issue of reproductive cloning. Development of vaccines against human papillomavirus (HPV) has introduced new ethical aspects related to reproductive health and the need for a consensus of clinical and public-healthcare population. Today immunization with HPV vaccine is a measure for the primary prevention of cervical cancer and it provides effective protection against certain types of viruses included in the vaccine. The most often mentioned issues of discussions on ethical concerns about HPV vaccination are the recommended age of girls who should be informed and vaccinated (12-14 years), attitudes and fears of parents concerning discussion with their preadolescent daughters on issues important for their future sexual behavior, dilemma on the vaccination of boys and the role of the chosen pediatrician in providing information on the vaccination. In Serbia, two HPV vaccines have been registered but the vaccination is not compulsory. Up-till-now there has been no researches on the attitudes of physicians and parents about HPV vaccination. Nevertheless, it is very important to initiate education of general and medical public about the fact that the availability of vaccine, even if we disregard all aforementioned dilemmas, does not lead to the neglect of other preventive strategies against cervical cancer, primarily screening. The National Program for Cervical Cancer Prevention involves organized screening, i.e. regular cytological examinations of the cervical smear of all women aged 25-69 years, every three years, regardless of the
In the past decade there have been an increasing number of scientific studies describing possible effects of air pollution on perinatal health. These papers have mostly focused on commonly monitored air pollutants, primarily ozone (O3), particulate matter (PM), sulfur dioxide (S...
Background In Southeast Asia, hundreds of thousands of young rural women migrate from their villages to the larger cities in search of work. Many find employment with beer companies or in the clubs where beer is sold, promoting the sale of beer. Previous research suggests these young migrants are in a highly vulnerable position. This paper will describe the findings of an October 2009 meeting to develop a research agenda on the sexual and reproductive health of beer promoters and a subsequent pilot study of focus groups with beer promoters to review this agenda. Methods Participants of the research meeting representing beer promoters, academics, non-governmental organizations (NGOs), government and the beer industry from Cambodia, Thailand, Laos, and Vietnam collaborated in the development of three key research themes. The themes were verified in focus group discussions with beer promoters organized by local research partners in all four countries. The focus group participants were asked what they felt were the key sexual and reproductive health issues facing them in a non-directive and unstructured manner, and then asked to comment more specifically on the research priorities developed at the meeting. The focus groups were recorded digitally, transcribed, and translated into English. The data were analyzed by coding for common themes and then developing matrices to compare themes between groups. Results The participants of the meeting identified three key research themes: occupational health (including harassment and violence, working conditions, and fair pay), gender and social norms (focusing on the impact of power relations between the genders on women's health), and reproductive health (knowledge and access to reproductive health care services). The participants in the focus groups in all four countries agreed that these were key priorities for them, though the emphasis on the most important issues varied between groups of women. Sexual harassment in the
This study investigated the association of the Wealth Index of married women in Egypt with a number of gender and reproductive health issues found in the 2005 Egypt Demographic Health Survey. The data from a subsample of 5249 currently married women from a total of 19,474 was examined using logistic regression analysis. The women's lowest wealth quintile predicted the intention to continue female genital cutting for their daughters, exposure to physical and sexual marital violence, not being empowered in household decisions, having a higher number of children, having an unintended last child, mothers' maltreatment of their children, the perception of a lack of health-care providers or drugs as an obstacle to receiving care, and not being covered by health insurance. The association of poverty with the aforementioned adverse health outcomes are discussed. Physicians should understand the effect of poverty on health and endeavour to influence policy-makers to reduce the poverty burden on health.
Folayan, Morenike Oluwatoyin; Haire, Bridget; Harrison, Abigail; Odetoyingbo, Morolake; Fatusi, Olawunmi; Brown, Brandon
There is increasing interest in the need to address the ethical dilemmas related to the engagement of adolescents in sexual and reproductive health (SRH) research. Research projects, including those that address issues related to STIs and HIV, adverse pregnancy outcomes, violence, and mental health, must be designed and implemented to address the needs of adolescents. Decisions on when an individual has adequate capacity to give consent for research most commonly use age as a surrogate rather than directly assessing capacity to understand the issues and make an informed decision on whether to participate in research or not. There is a perception that adolescents participating in research are more likely to be coerced and may therefore not fully comprehend the risk they may be taking when engaging in research. This paper examines the various ethical issues that may impact stakeholders' decision making when considering engaging adolescents in SRH research in Nigeria. It makes a case for lowering the age of consent for adolescents. While some experts believe it is possible to extrapolate relevant information from adult research, studies on ethical aspects of adolescents' participation in research are still needed, especially in the field of sexual and reproductive health where there are often differences in knowledge, attitudes and practices compared to adults. The particular challenges of applying the fundamental principles of research ethics to adolescent research, especially research about sex and sexuality, will only become clear if more studies are conducted.
Gillette, Meghan T; Folinsbee, Kaila E
The age at which a female reaches sexual maturity is critical in determining her future reproductive health and success. Thus, a worldwide decline in menarcheal age (timing of first menstrual period) may have serious long-term consequences. Early menarcheal timing (first menstrual period before age 12) can have a negative effect on fecundity, as well as the quality and quantity of offspring, and may consequently influence population growth or decline. In this paper, we apply an evolutionary framework to modern human health, and assess both proximate and ultimate consequences of declining menarcheal age. Examination of human reproductive health within an evolutionary framework is innovative and essential, because it illuminates the ultimate consequences of a declining age of menarche and facilitates new ways of thinking about the long-term and intergenerational transmission of health and disease; thus, an evolutionary framework lends itself to innovative public health and policy programs. In this paper, we examine whether or not early menarche is an alternative reproductive tactic that modern human females employ in response to a stressful environment, and whether or not early menarche is ultimately beneficial.
As Latin American countries seek to guarantee sexual and reproductive health and rights, opponents of women's rights and reproductive choice have become more strident in their opposition, and are increasingly claiming conscientious objection to providing these services. Conscientious objection must be seen in the context of the rights and interests at stake, including women's health needs and right to self-determination. An analysis of law and policy on conscientious objection in Peru, Mexico and Chile shows that it is being used to erode women's rights, especially where it is construed to have no limits, as in Peru. Conscientious objection must be distinguished from politically-motivated attempts to undermine the law; otherwise, the still fragile re-democratisation processes underway in Latin America may be placed at risk. True conscientious objection requires that a balance be struck between the rights of the objector and the health rights of patients, in this case women. Health care providers are entitled to their beliefs and to have those beliefs accommodated, but it is neither viable nor ethically acceptable for conscientious objectors to exercise this right without regard for the right to health care of others, or for policy and services to be rendered ineffectual because of individual objectors.
... NICHD Research Information Clinical Trials Resources and Publications Men's Reproductive Health: Overview Skip sharing on social media ... Content Reproductive health is an important component of men's overall health and well-being. Too often, males ...
Chan, Chrystal; Costain, Gregory; Ogura, Lucas; Silversides, Candice K.; Chow, Eva W.C.
22q11.2 deletion syndrome (22q11.2DS) is the most common microdeletion syndrome in humans. Survival to reproductive age and beyond is now the norm. Several manifestations of this syndrome, such as congenital cardiac disease and neuropsychiatric disorders, may increase risk for adverse pregnancy outcomes in the general population. However, there are limited data on reproductive health in 22q11.2DS. We performed a retrospective chart review for 158 adults with 22q11.2DS (75 male, 83 female; mean age 34.3 years) and extracted key variables relevant to pregnancy and reproductive health. We present four illustrative cases as brief vignettes. There were 25 adults (21>age 35 years; 21 female) with a history of one or more pregnancies. Outcomes for women with 22q11.2DS, compared with expectations for the general population, showed a significantly elevated prevalence of small for gestational age liveborn offspring (p<0.001), associated mainly with infants with 22q11.2DS. Stillbirths also showed elevated prevalence (p<0.05). Not all observed adverse events appeared to be attributable to transmission of the 22q11.2 deletion. Recurring issues relevant to reproductive health in 22q11.2DS included the potential impact of maternal morbidities, inadequate social support, unsafe sexual practices, and delayed diagnosis of 22q11.2DS and/or lack of genetic counseling. These preliminary results emphasize the importance of early diagnosis and long term follow-up that could help facilitate genetic counseling for men and women with 22q11.2DS. We propose initial recommendations for pre-conception management, educational strategies, pre-natal planning, and preparation for possible high-risk pregnancy and/or delivery. PMID:25579115
Tadevosian, N S; Muradian, S A; Tadevosian, A E; Khachatrian, B G; Dzhandzhapanian, A N; Parsadanian, G G; Pogosian, S B; Gevorkian, N B; Guloian, A A
Investigations aimed at the study on the state of environment from the point of pollution by organochlorine pesticides and their metabolites (HCH, DDT, DDE and DDD), as well as on possible unfavorable impact due to carriage of mentioned persistent organic pollutants (POPs) towards reproductive health and cytogenetic status of organism were done. In parallel, monitoring of possible mutagenic components of the environment was also conducted. As to obtained data, residues of organochlorine pesticides are continually determined with high frequency both in environmental media, agricultural foodstuffs and biomedia of rural population of observed region (Aragatsotn marz, Armenia). No changes in mutagenic background were registered. The represented results of the study make fragment of complex social-hygienic, monitoring investigations on environmental quality that would further serve as a platform for working out the recommendations on reduction of environmental pollution and improvement of health protection issues in Armenia.
Motsomi, Kegaugetswe; Makanjee, Chandra; Basera, Tariro; Nyasulu, Peter
Introduction Communication between parents and adolescents regarding sexuality is an important reproductive health topic. Due to complexities associated with adolescent's physiological development, sexuality should be dealt with holistically. This study aimed to investigate factors affecting effective communication between parents and adolescents concerning sexual and reproductive health issues. Methods An exploratory qualitative study using the focus group discussions method was done to explore amongst other things; social, cultural and religious barriers to communication. Thematic content analysis was done. Results Factors identified included: embarrassment when discussing sexual topics; adolescent misperceptions that guardians want to engage in sexual activities with them; strong belief amongst guardians that reproductive health discussions with adolescents encourages sexual experimentation; belief that adolescents were too young to understand; non-conducive environment for open discussions of sexual and reproductive health matters; cultural and religious beliefs. Conclusion In view of these findings, there are still barriers in terms of parent-adolescent engagement on issues related to risks associated with sexual behaviours and erroneous reproductive health choices among adolescents. Therefore, there is a need to encourage engagement by creating neutral platforms facilitated by community healthcare providers and/ or social workers. This will help create awareness and bridge the communication and interaction gap by emphasising the importance of effective engagement among adolescents and their parents on matters related to risks associated with sexual behaviours and erroneous reproductive health choices. Post implantation intervention studies are needed to inform on the outcomes of the intervention. PMID:28292083
Several events in Zambia this year have marked the development of an integrated approach to reproductive health. A team met in March to draw up a national safe motherhood policy, plus strategies and guidelines. These were completed by April and are being distributed for comments. Clinical guidelines for safe motherhood in health centers have also been developed. These aim to reduce mortality and morbidity among mothers and infants by helping health workers to provide quality care to women at every stage of pregnancy and delivery. A reproductive health workshop was held in Ngwerere in May to create awareness of the concept of reproductive health, identify reproductive health problems in the area, propose solutions and outline activities. The 75 participants included community health workers, community leaders, teachers, youth leaders, and community members, as well as health workers and policymakers. The workshop was conducted in the local language so that those present were able to participate fully. June 1997 saw the official launch of Zambia's new policy framework, guidelines and strategy on family planning within reproductive health. The country's Minister of Health, Dr. Katele Kalumba, said the family planning guidelines were a sign of the government's commitment to providing a basic health care package for all Zambians. To promote widespread discussion of the whole concept of reproductive health, local newspapers printed feature articles with the headline "Let's talk reproductive health." The articles raised a variety of sensitive issues that ranged from safe sex and adolescent sexuality to safe motherhood and HIV prevention. Plans are going ahead in Zambia for drawing up a national training curriculum for safe motherhood and family planning. The curriculum for health workers will cover both pre-service and in-service training.
Hoffman, Elizabeth R; Zerwas, Stephanie C; Bulik, Cynthia M
Despite a high prevalence of menstrual irregularities, women with anorexia nervosa are becoming pregnant. The physical and psychological demands of pregnancy and motherhood can represent an immense challenge for women already struggling with the medical and psychological stress of an eating disorder. This article summarizes key issues related to reproduction in women with anorexia nervosa, highlighting the importance of preconception counseling, adequate gestational weight gain, and sufficient pre- and post-natal nutrition. Postpartum issues including eating disorder symptom relapse, weight loss, breastfeeding, and risk of perinatal depression and anxiety are also discussed. PMID:22003362
Friedman, H L
The health and well-being of adolescents is closely intertwined with their physical, psychological and social development, but this is put at risk by sexual and reproductive health hazards which are increasing in much of the world. Changes in population growth and distribution, the rise of telecommunications, the increase in travel and a decline in the family, as well as a generally earlier start of menarche and later age of marriage are contributing to an increase in unprotected sexual relations before marriage. This, combined with risks from early marriage, result in too early or unwanted pregnancy and childbirth, induced abortion in hazardous circumstances and sexually transmitted diseases, including HIV infection leading to AIDS. With more than half the world's population below the age of 25, and 4 out of 5 young people living in developing countries with inadequate access to prevention and care, there is an urgent need for action. Young women are particularly vulnerable. Mortality and morbidity from early pregnancy whether ending in childbirth or abortion, is much higher for the younger adolescent. Young women, especially those who have less formal education, are more vulnerable to pressures for marriage, or sexual relations before marriage, often with older men. Young people generally lack adequate knowledge about their own development and information on how to get help. Those who could help are rarely trained for working with adolescents, and services which are generally designed for adults or children often deter young people from getting help when they most need it. Policy and legislation relating to sexual and reproductive health issues are often contradictory, and unclear or unenforced.(ABSTRACT TRUNCATED AT 250 WORDS)
Stephenson, Rob; Tsui, Amy Ong; Sulzbach, Sara; Bardsley, Phil; Bekele, Getachew; Giday, Tilahun; Ahmed, Rehana; Gopalkrishnan, Gopi; Feyesitan, Bamikale
Objectives Networks of franchised health establishments, providing a standardized set of services, are being implemented in developing countries. This article examines associations between franchise membership and family planning and reproductive health outcomes for both the member provider and the client. Methods Regression models are fitted examining associations between franchise membership and family planning and reproductive health outcomes at the service provider and client levels in three settings. Results Franchising has a positive association with both general and family planning client volumes, and the number of family planning brands available. Similar associations with franchise membership are not found for reproductive health service outcomes. In some settings, client satisfaction is higher at franchised than other types of health establishments, although the association between franchise membership and client outcomes varies across the settings. Conclusions Franchise membership has apparent benefits for both the provider and the client, providing an opportunity to expand access to reproductive health services, although greater attention is needed to shift the focus from family planning to a broader reproductive health context. PMID:15544644
Santy, Patricia A.; Jennings, Richard T.
A review of reproductive functioning in animal species studied during space flight demonstrated that most species were affected significantly by the absence of gravity and/or the presence of radiation. These two factors induced alterations in normal reproductive functioning independently of, as well as in combination with, each other. Based on animal models, several potential problem areas regarding human reproductive physiology and functioning in the space environment were identified. While there are no current space flight investigations, the animal studies suggest priorities for future research in human reproduction. Such studies will be critical for the successful colonization of the space frontier.
Alexandrova-Yankulovska, S; Bozhinov, P; Bojinova, S
Medical progress has enabled achievements that were not even thinkable earlier but at the same time society and public health have had to face new challenges. What are we ready to accept in the area of human reproduction? This paper aims at ethical analysis of Bulgarian laws on reproduction. The abortion debate nowadays has got new dimiension focusing not that much on its moral acceptability but rather on the acceptable indications for its performance. Is it ethical to perform abortion in case of undesired gender of the embryo or genetic malformations? Lots of moral issues mark the area of assisted reproduction which is due to the separation of the reproductive functions (ova, sperm and embryo donation, surrogacy), fragmentation of motherhood and fatherhood, differentiation of biological and social parenthood. Defining limits of acceptable interference or non-interference in human reproduction will never be easy, but dynamics of moral judgment shouldn't bother us. The rigidity of moral norms is what should be alarming because it threatens procreative autonomy.
Perla, M. E.; Ghee, Annette E.; Sánchez, Sixto; McClelland, R. Scott; Fitzpatrick, Annette L.; Suárez-Ognio, Luis; Lama, Javier R.; Sánchez, Jorge
Sociodemographic and behavioral characteristics of 212 Peruvian female sex workers (FSWs) were analyzed. The association between genital tract infections (GTIs) and risk factors by multivariate analysis was evaluated. Eighty-eight percent of FSWs were diagnosed with at least one GTI (HSV-2 80.1%, BV 44.8%, candidiasis 9.9%, syphilis seropositivity 9.4%, Trichomonas vaginalis 2.4%, HIV seropositivity 2.4%). Reported condom use with clients was nearly universal (98.3%), but infrequent with husband/regular partners (7.3%). In multivariate analysis BV was negatively associated with more consistent condom use (PRR = 0.63, 95% CI, 0.42–0.96). Many had not visited a Sexually Transmitted Infection (STI) clinic or been tested for HIV in the past year (40.6%, 47.1%, resp.). Nonclient contraceptive use was low (57%) and induced abortion was common (68%). High GTI burden and abortions suggest that a services-access gap persists among marginalized FSWs. Continued health outreach programs and integrating family planning and reproductive health services into existing STI clinic services are recommended. PMID:22811592
Perla, M E; Ghee, Annette E; Sánchez, Sixto; McClelland, R Scott; Fitzpatrick, Annette L; Suárez-Ognio, Luis; Lama, Javier R; Sánchez, Jorge
Sociodemographic and behavioral characteristics of 212 Peruvian female sex workers (FSWs) were analyzed. The association between genital tract infections (GTIs) and risk factors by multivariate analysis was evaluated. Eighty-eight percent of FSWs were diagnosed with at least one GTI (HSV-2 80.1%, BV 44.8%, candidiasis 9.9%, syphilis seropositivity 9.4%, Trichomonas vaginalis 2.4%, HIV seropositivity 2.4%). Reported condom use with clients was nearly universal (98.3%), but infrequent with husband/regular partners (7.3%). In multivariate analysis BV was negatively associated with more consistent condom use (PRR = 0.63, 95% CI, 0.42-0.96). Many had not visited a Sexually Transmitted Infection (STI) clinic or been tested for HIV in the past year (40.6%, 47.1%, resp.). Nonclient contraceptive use was low (57%) and induced abortion was common (68%). High GTI burden and abortions suggest that a services-access gap persists among marginalized FSWs. Continued health outreach programs and integrating family planning and reproductive health services into existing STI clinic services are recommended.
Obaid, Thoraya Ahmed
This essay examines the relationship between religion and public policy issues concerning reproductive health and rights. It particularly focuses on how such issues affect women. Although not ignoring the sometimes oppositional stance of some religious spokepersons to birth control and attempts to mitigate the suffering caused by HIV/AIDS, early or frequent pregnancy, discrimination against female fetuses and babies, and so on, the essay seeks to identify positive responses by religiously committed people, particularly women, that parallel or reinforce UNFPA initiatives to address such problems. The essay also attempts to articulate ways in which religion should come to grips with issues of reproductive health and rights.
The last quarter of the twentieth century has given rise to reproductive technologies and arrangements that in the earlier part of the century could only be dreamed of by the authors of science fiction. We stand in the middle of this reproductive revolution, trying to cope with the developments that have already occurred but with an uneasy sense that the future may be even more complicated ethically than the past and the present. In this brief essay, I will survey recent ethical and public-policy discussions of two reproductive techniques (assisted insemination and in vitro fertilization) and one reproductive arrangement (surrogate motherhood). After distinguishing three phases in the normative debate, I will briefly comment on some of the characteristics of, and continuing ambiguities in, the ethical debate of the past 25 years. At the conclusion of the essay, I will attempt to anticipate three future issues in ethics and reproduction.
In India, prenatal tests are used to determine the sex of the fetus and, if it is female, it is often aborted. In response to sex discrimination in utero, the Forum against Sex Determination and Sex Preselection was formed in 1985. It began a campaign against using prenatal tests to determine sex for the subsequent abortion of female fetuses. The 1989 Maharashtra Regulation of Prenatal Diagnostic Techniques was a direct result of this campaign. The forum expanded to examine other reproductive technologies, particularly long-lasting contraceptives that cause systemic changes in women's bodies, and it has become more concerned about women's rights in general. It has renamed itself the Forum for Women's Health. The state translates the need for contraceptives into population control. It provides health care through primary health centers and subcenters. The maternal and child health program provides health care only to 15-45 year old women. The government knows that abortion and childbirth are major contributors to maternal mortality, so it provides safe abortion through its centers. Yet, prevailing conditions and social values keep women from using these services, so they resort to unhygienic abortions. The government considers repeated childbearing as the only cause of maternal mortality and ignores that poverty, malnutrition, and social position can also be responsible for maternal deaths. This attitude justifies its coercion of women to use contraception. India's government is presently pushing provider-controlled, long-acting methods. It supports high tech research of antifertility vaccines. Female barrier methods are not marketed. The family planning program is based on targets and incentives/ disincentives. The government has recently set up sterilization camps in Bombay. The forum is concerned that providers will not fully inform women about side effects of the injectables and about other possible contraceptive methods. Women are being trained in self-help and
Agarwal, Utkarsha; Muralidhar, Sumathi
Background and Objectives: Physically challenged people constitute the most stigmatized sections of society, and are excluded from outreach programs, besides being considered sexually inactive. They have unaddressed sexual and reproductive healthcare (SRH) issues, predisposing them to sexual abuse and sexually transmitted infections (STIs). The huge paucity of data in this field prompted us to undertake this study. Materials and Methods: A cross-sectional survey was conducted on 100 people with more than 40% of permanent disability, attending various out/inpatient facilities of a tertiary care hospital in New Delhi, India. A structured, pretested questionnaire was used to assess SRH issues. Samples were collected from consenting individuals for diagnosis of various STIs, wherever relevant. Statistical analysis was done using Pearson's Chi-square test, considering significant at P <0.05. Results: Most people were in the age group of 15–30 years. Limbs were most commonly affected, and the use of assistive devices was statistically related to income levels (P = 0.045), 43% was married and 41% had children. Contraceptive usage was 33%, with a significant association (P = 0.03) with education levels. Issues related to sexual health included conditions ranging from nerve sensation loss in genitalia to fertility and gynecological issues, only 10% had received sexual counseling during rehabilitation. There were several misconceptions prevalent regarding HIV and STIs; 35% of the samples tested positive for chlamydia IgG. Interpretation and Conclusions: This is a pioneer study on a grossly neglected issue in India. There is a dire need to overcome hurdles and address the SRH issues of physically challenged people to achieve the universal WHO goal of “Health for All.” PMID:27890951
Sengupta, Pallav; Chaudhuri, Prasenjit; Bhattacharya, Koushik
Now-a-days reproductive health problems along with infertility in male is very often observed. Various Assisted Reproductive Technologies have been introduced to solve the problem, but common people cannot afford the cost of such procedures. Various ayurvedic and other alternative medicines, along with regular yoga practice are proven to be not only effective to enhance the reproductive health in men to produce a successful pregnancy, but also to regulate sexual desire in men who practice celibacy. Yoga is reported to reduce stress and anxiety, improve autonomic functions by triggering neurohormonal mechanisms by the suppression of sympathetic activity, and even, today, several reports suggested regular yoga practice from childhood is beneficial for reproductive health. In this regard the present review is aimed to provide all the necessary information regarding the effectiveness of yoga practice to have a better reproductive health and to prevent infertility. PMID:23930026
Serour, G I
Sexual and reproductive rights of women are essential components of human rights. They should never be transferred, renounced or denied for any reason based on race, religion, origin, political opinion or economic conditions. Women have the right to the highest attainable standard of health care for all aspects of their reproductive and sexual health (RSH). The principle of autonomy emphasizes the important role of women in the decision-making. Choices of women in reproduction, after providing evidence based information, should be respected. Risks, benefits and alternatives should be clearly explained before they make their free informed consent. Justice requires that all be treated with equal standard and have equal access to their health needs without discrimination or coercion. When resources are limited there is tension between the principle of justice and utility. Islamic perspectives of bioethics are influenced by primary Sharia namely the Holy Quran, authenticated traditions and saying of the Profit Mohamed (PBUH), Igmaa and Kias (analogy). All the contemporary ethical principles are emphasized in Islamic Shariaa, thus these principles should be observed when providing reproductive and sexual health services for Muslim families or communities. The Family is the basic unit in Islam. Safe motherhood, family planning, and quality reproductive and sexual health information and services and assisted reproductive technology are all encouraged within the frame of marriage. While the Shiaa sect permits egg donation, and surrogacy the Sunni sect forbids a third party contribution to reproduction. Harmful practices in RSH as FGM, child marriage and adolescent pregnancy are prohibited in Islam. Conscientious objection to treatment should not refrain the physician from appropriate referral.
This address was given by Dr. Gro Harlem Brundtland at the ICPD+5 Forum in The Hague, Netherlands, 8-12 February, 1999. He commented that failure to respond to the reproductive health needs of the people is a matter of human rights and social justice. People have the right to make free and informed decisions on their reproductive lives. The right to have an information and care that would allow them to decide whether or not to protect their reproductive health and that of their loved ones. Moreover, a freedom to benefit from scientific progress in health care. In addition, the right to equality and nondiscrimination on the basis of sex, marital status, race, age and class should never be forgotten. People have the right to maintain their privacy and to freedom from sexual violence. Defining reproductive ill health as not merely a health issue, but rather, a matter of social justice offering legal and political grounds for governments to take action. Government and civil society need to develop a public health approach to reproductive health that is cost-effective and has the maximum impact of addressing the underlying social causes of poverty, starvation, and ill health.
Aisen, Mindy Lipson
Sexuality is the embodiment of sexual and reproductive activities involving complex interactions among biological, psychological, and social systems. An individual's perception of their sexuality, as well as society's perception, can have an inestimable impact on self-esteem, and hence willingness to openly address these issues Earle S (2001). Disability, facilitated sex and the role of the nurse. J Adv Nurs 3: 433-440. Such barriers to communication represent a real challenge to practicing clinicians. However, advances in treatment options obligate the clinician providing care to those with neurogenic sexual/reproductive dysfunction to learn to communicate effectively about these issues, provide effective therapies, and refer patients to appropriate specialists. This chapter will address counseling, an overview of male and female sexual and reproductive physiological responses in the case of an intact nervous system, and a description of the impact of disorders of the nervous system on sexual function and reproductive health. Treatment options are also reviewed.
Moeti, M R
The underlying factors of poverty, migration, marginalization, lack of information and skills, disempowerment, and poor access to services which affect HIV/STD risk are also closely related to those which affect sexual and reproductive health. Reproductive health problems include unplanned and unwanted pregnancies, unsafe abortions, pregnancy-related illness and death, and STDs including HIV/AIDS. This interrelationship between factors is leading increasingly to the integration of HIV/STD education and prevention within the broader framework of sexual and reproductive health promotion. Such intervention allows the possible reinforcement of the impact of interventions upon important underlying factors and behaviors linked to individual, family, and community vulnerability to HIV/STDs as well as other reproductive health problems. Integration will also optimize the use of increasingly scarce resources and increase the likelihood of responses, interventions, and programs being sustainable. Sexual and reproductive health, placing HIV/STD prevention into context, and focus upon men are discussed.
Nearly one third of Nigeria's total population of 148.1 million is between the ages of 10 and 24. Nigerian adolescents' sizeable share of the population makes them integral to the country's social, political and economic development. Nigeria's development is compromised by the sexual and reproductive health issues afflicting its youth. Lack of…
Stock, Susan R.; Levine, Heidi
This chapter provides an overview of common student mental health issues and approaches for student affairs practitioners who are working with students with mental illness, and ways to support the overall mental health of students on campus.
Ndong, I; Finger, W R
Before the advent of the oral contraceptive pill, men were more involved in family planning and other aspects of reproductive health. Then, if a couple wished to practice family planning, they were largely limited to withdrawal, periodic abstinence, and condom use, all practices which require the man's participation. Hormonal methods for women and the subsequent development of IUDs and modern surgical sterilization fostered the development of a family planning services community focused upon women rather than men. The challenge is now to increase the degree of male responsibility for family planning by expanding services in ways which protect the reproductive health of both men and women, and by encouraging greater sensitivity to gender issues. Adding reproductive health services for men can be done without reducing the level of services available for women. However, while PROFAMILIA clinics, which offer a wide range of male reproductive health services, have found ways to encourage male participation, an enormous gap exists between the rhetoric of promoting male involvement and the actual realities of female-oriented reproductive health programs. Obstacles include men's reluctance to use services, lack of knowledge among men about their own and women's sexuality, lack of communication by men about sexuality in their relationships, male beliefs in sexual myths, health providers' and false assumptions and generalizations about men. The authors discuss the need to encourage men to support women's contraceptive choices, to increase communication between partners, to increase the use of male methods, to improve men's behavior for the prevention of STDs, to address men's reproductive health needs, and to encourage men to become more aware of related family issues.
Molinelli, A; Motroni Gherardi, S M; Picchioni, D M; Ventura, F
The authors analyze the legal and medico-legal issues deriving from the recent Law No. 40 of February 19, 2004 concerning the Medically Assisted Reproduction. In particular, they analyze the contrasting points between the dispositions of Law No. 40/2004 and those of Law No. 194/1978 on the voluntary interruption of pregnancy, and they analyze the guidelines about the procedures and the techniques of the Medically Assisted Reproduction, issued by the Ministry of Health with D.M. of July 21, 2004. The Guidelines, as well as some sentences of several courts, lead to some reflections also about the consent and the professional liability, in particular considering the various moments of the medical action, from the first interview to the carrying out of the assisted reproduction techniques.
Yumiko Jansson-Yanagisawa, a member of Women's Health and Rights, Japan, believes that Japan's Criminal Law, which outlawed abortion 100 years ago, and Eugenic Protection Law (1948), which permits abortion under 5 conditions (the 4th covers the health and economic situation of the mother), should be replaced by a new law that guarantees safe abortion on demand. Her group organizes educational meetings and discussion forums. They have produced a film (a Japanese version of Abortion Stories from North and South, with an accompanying book of responses to the issues raised by the film) and a book (Dangerous Reproductive Revolution) on reproductive technology. In 1990, they unsuccessfully tried to block an attempt to decrease the legal time period for an abortion from 24 weeks to less than 22 weeks. Believing that abortion is a health issue, rather than an ethical one, they would like to see a reference resource of abortion research and statistics for Japan. A larger, national women's organization for reproductive health could conduct research and handle legal issues and paramedical elements of women's health. All aspects of abortion should be illuminated.
Schenker, J G
It is important to those who practice reproduction techniques to learn about the different religious attitudes related to reproductive health problems. Religion exerts an influence on civil authorities in the field of reproduction such as prevention or procreation and in issues such as abortion and infertility therapy. The Jewish attitude towards reproduction can be learned from the fact that the first commandment of God to Adam was be fruitful and multiply. Judaism allows the practice of all techniques of assisted reproduction when the oocyte and sperm originate from the wife and husband, respectively. All Rabbinical rulings permit the use of contraception for medical indications. Economic difficulties and inconveniences of raising children are not indications for birth control practice. According to Judaism abortion on demand is forbidden but it may be performed if the mother's life is in danger. The attitude toward reproductive practice is different among the different divisions of Christianity. The practice of assisted reproduction is not accepted by the Vatican, however, it may be practiced by Protestant, Anglican and other Denomination's. According to the Roman Catholic doctrine the primary purpose of marriage is procreation. The contraceptive act destroys the potential of producing new life by sexual intercourse and violates the purpose of marriage and, therefore, is a sin against nature. The Christian tradition views the embryo as a human being since conception and, therefore, abortion is strictly forbidden. According to Islam, the procedure of IVF and ET is acceptable, however, it can be preformed only if it involves the husband and the wife. It allows contraception practice only under some circumstances and only in some special cases abortion can be preformed. Religion, being concerned with affairs that are regarded as extraordinary and as having unique importance in life, is an intrinsic aspect of the culture of all societies, religious groups, however
Pillai, Vijayan K.; Gupta, Rashmi
Background Research on reproductive health in developing countries focuses mostly on the role of economic development on various components of reproductive health. Cross-sectional and empirical research studies in particular on the effects of non-economic factors such as reproductive rights remain few and far between. Objective This study investigates the influence of two components of an empowerment strategy, gender equality, and reproductive rights on women's reproductive health in developing countries. The empowerment strategy for improving reproductive health is theoretically situated on a number of background factors such as economic and social development. Design Cross-national socioeconomic and demographic data from a number of international organizations on 142 developing countries are used to test a model of reproductive rights and reproductive health. Results The findings suggest that both economic and democratic development have significant positive effects on levels of gender equality. The level of social development plays a prominent role in promoting reproductive rights. It is found that reproductive rights channel the influences of social structural factors and gender equality on reproductive health. PMID:22184501
Beginning in the mid-1800s, the American Medical Association, antiobscenity crusaders, and even women's groups supported criminalization of abortion. By 1900, it was illegal nationwide. In the late 1960s, women, physicians, and states began questioning abortion laws, since many women had unsafe, often fatal, illegal abortions. By 1973, 4 states had legalized abortion and 15 other states had liberalized abortion laws. A mid-1960 study showed that private patients comprised about 95% of all elective abortions. Poor clinic patients did not have the power to convince 3 physicians to support their request for an abortion. IN 1965, the Supreme Court agreed that a Connecticut Planned Parenthood Affiliate had the right to distribute contraceptives. The 1973 Roe v. Wade Court decision advanced this decision, by confirming a woman's right to abortion during the first 2 semesters of pregnancy. In 1976, the US Congress passed the Hyde amendment forbidding federal funding (e.g., Medicaid) for abortions except to save a mother. 2 1980 Supreme Court decisions supported the Hyde amendment. The Hyde amendment and these court decisions showed discrimination against poor women. Since then there have been other decisions that have whittled away at Roe v. Wade. Contraceptive failure is responsible for about 50% of the 1.6 million abortions/year. About 60% of women having an abortion are under 25 years old. Thus, criminalization of abortion would adversely affect many women as well as society. Many prochoice physicians had cared for women who suffered from botched abortions. Physicians under 45 years old tend to not know how to perform a 2nd trimester abortion because most obstetrician/gynecology residency training programs do not require them to learn it, and they do not want to do them. 2nd trimester abortion should be a required part of residency training. Physicians as preservers of women's health should be advocating safe abortion and not adopt the legal vs. illegal abortion
One widely held view of prenatal screening (PNS) is that its foremost aim is, or should be, to enable reproductive choice; this is the Pure Choice view. The article critiques this position by comparing it with an alternative: Public Health Pluralism. It is argued that there are good reasons to prefer the latter, including the following. (1) Public Health Pluralism does not, as is often supposed, render PNS more vulnerable to eugenics-objections. (2) The Pure Choice view, if followed through to its logical conclusions, may have unpalatable implications, such as extending choice well beyond health screening. (3) Any sensible version of Public Health Pluralism will be capable of taking on board the moral seriousness of abortion and will advocate, where practicable, alternative means of reducing the prevalence of disease and disability. (4) Public Health Pluralism is at least as well-equipped as the Pure Choice model to deal with autonomy and consent issues. PMID:25521971
Schuster, Mark A; Chung, Paul J; Vestal, Katherine D
All children, even the healthiest, have preventive and acute health care needs. Moreover, a growing number of children are chronically ill, with preventive, acute, and ongoing care needs that may be much more demanding than those for healthy children. Because children are unable to care for themselves, their parents are expected to provide a range of health care services without which the current health care system for children would not function. Under this "shadow health care system," parents or parent surrogates often need to be with the child, a requirement that can create difficulties for working parents, particularly for those whose children are chronically ill. How federal, state, and employer policies and practices mesh with the child health care needs of families is therefore a central issue in any discussion about work and family balance. In this article Mark Schuster, Paul Chung, and Katherine Vestal describe the health care needs of children; the essential health care responsibilities of parents; the perspective of employers; and the existing network of federal, state, and local family leave benefits that employed parents can access. They also identify current gaps in policies that leave unmet the needs of both parents and their employers. The authors suggest the outlines of a national family leave policy that would protect the interests of parents and employers. In essence, such a policy would build on the federal Family and Medical Leave Act, which gives some workers time off with no advance notice required and no loss of job or health insurance. But it would also include elements of California's Paid Family Leave Insurance, which expands coverage to more workers and provides partial pay during leave. Employers could be given some financial protections as well as protections against employee fraud and abuse. Such a policy, the authors conclude, would help to provide security to parents, minimize effects on employers, raise societal expectations for
In an opinion later vacated (Reproductive Health Services v. Freeman, Federal Reporter, 2d series, 634: 1133-1134), the U.S. Court of Appeals for the Eighth Circuit held invalid a Missouri medical assistance regulation which provided public subsidy of abortions only when a full-term pregnancy and childbirth would be fatal to the ¿mother. Further, the court found that Missouri's Medicaid exclusion for therapeutic abortions--those for which the state would not be reimbursed under the federal Hyde Amendment--was also invalid under the equal protection clause and because it excluded this one medically necessary procedure without a legitimate state interest in doing so.
Cook, R J
Neglect of women's reproductive health, perpetuated by law, is part of a larger, systematic discrimination against women. Laws obstruct women's access to reproductive health services. Laws protective of women's reproductive health are rarely or inadequately implemented. Moreover, few laws or policies facilitate women's reproductive health services. Epidemiological evidence and feminist legal methods provide insight into the law's neglect of women's reproductive health and expose long-held beliefs in the law's neutrality that harm women fundamentally. Empirical evidence can be used to evaluate how effectively laws are implemented and whether alternative legal approaches exist that would provide greater protection of individual rights. International human rights treaties, including those discussed in this article, are being applied increasingly to expose how laws that obstruct women's access to reproductive health services violate their basic rights.
Potts, Malcolm; Henderson, Courtney E
The largest absolute numbers of maternal deaths occur among the 40-50 million women who deliver annually without a skilled birth attendant. Most of these deaths occur in countries with a total fertility rate of greater than 4. The combination of global warming and rapid population growth in the Sahel and parts of the Middle East poses a serious threat to reproductive health and to food security. Poverty, lack of resources, and rapid population growth make it unlikely that most women in these countries will have access to skilled birth attendants or emergency obstetric care in the foreseeable future. Three strategies can be implemented to improve women's health and reproductive rights in high-fertility, low-resource settings: (1) make family planning accessible and remove non-evidenced-based barriers to contraception; (2) scale up community distribution of misoprostol for prevention of postpartum hemorrhage and, where it is legal, for medical abortion; and (3) eliminate child marriage and invest in girls and young women, thereby reducing early childbearing.
Zotti, Marianne E; Williams, Amy M; Robertson, McKaylee; Horney, Jennifer; Hsia, Jason
We examined methodological issues in studies of disaster-related effects on reproductive health outcomes and fertility among women of reproductive age and infants in the United States (US). We conducted a systematic literature review of 1,635 articles and reports published in peer-reviewed journals or by the government from January 1981 through December 2010. We classified the studies using three exposure types: (1) physical exposure to toxicants; (2) psychological trauma; and (3) general exposure to disaster. Fifteen articles met our inclusion criteria concerning research focus and design. Overall studies pertained to eight different disasters, with most (n = 6) focused on the World Trade Center attack. Only one study examined pregnancy loss, i.e., occurrence of spontaneous abortions post-disaster. Most studies focused on associations between disaster and adverse birth outcomes, but two studies pertained only to post-disaster fertility while another two examined it in addition to adverse birth outcomes. In most studies disaster-affected populations were assumed to have experienced psychological trauma, but exposure to trauma was measured in only four studies. Furthermore, effects of both physical exposure to toxicants and psychological trauma on disaster-affected populations were examined in only one study. Effects on birth outcomes were not consistently demonstrated, and study methodologies varied widely. Even so, these studies suggest an association between disasters and reproductive health and highlight the need for further studies to clarify associations. We postulate that post-disaster surveillance among pregnant women could improve our understanding of effects of disaster on the reproductive health of US pregnant women.
Folsom, Lisal J; Fuqua, John S
Turner syndrome is one of the most common chromosomal abnormalities affecting female infants. The severity of clinical manifestations varies and it affects multiple organ systems. Women with Turner syndrome have a 3-fold increase in mortality, which becomes even more pronounced in pregnancy. Reproductive options include adoption or surrogacy, assisted reproductive techniques, and in rare cases spontaneous pregnancy. Risks for women with Turner syndrome during pregnancy include aortic disorders, hepatic disease, thyroid disease, type 2 diabetes, and cesarean section delivery. Providers must be familiar with the risks and recommendations in caring for women with Turner syndrome of reproductive age.
Mohammadi, Fatemeh; Kohan, Shahnaz; Mostafavi, Firoozeh; Gholami, Ali
Background: Fear of the stigma associated with reproductive health services has always been one of the reasons why youth and unmarried individuals avoid making use of such services. This stigma imposes a great deal of mental stress, fear, and depression on patients and causes delays in the diagnosis and treatment of their conditions. Objectives: This paper explores the concept of stigma in the context of the utilization of reproductive health services by unmarried women. Patients and Methods: This study is qualitative in nature. Purposive sampling was employed, and semi-structured interviews were conducted with 16 unmarried women, five midwives, and two physicians. The data were analyzed using the conventional content analysis method. Results: Four main categories constituted the general concept concerning the stigma suffered by unmarried women for using reproductive health services, i.e., prevalent stereotypical thinking patterns in society, the fear of being judged and labeled by others, discrimination, and feeling ashamed of seeking reproductive health services. Conclusions: The findings indicated that society associates reproductive health issues with sexual relations, which in turn shapes the stigma and places limitations on unmarried women for using reproductive health services. Thus, while reproductive health services are planned and provided to unmarried women, strategies are demanded for overcoming this stigma. PMID:27247794
Paxman, J M
This article surveys legal and policy approaches to adolescent health care programs and presents data on the availability of sex education programs, contraception, and abortion for adolescents in selected countries in the developed and developing world. The age at which youth are considered legally able reach independent decisions on matters affecting their health varies from country to country, although there is a trend toward setting the "age of majority" at 18 years. There has also been a trend toward viewing laws that require parental consent to health care and treatment as a barrier to health rather than a form of protection. Alternative legal approaches to the dilemma of consent have included lowering the age of majority for purposes of medical treatment, permitting professionals tojude whether an adolescent has sufficient maturity to give consent, and the use of third-party consent (e.g. child advocate). Cultural diversity mitigates against a universal legal approach to reproductive health education. There is wide variation in the policy response to questions such as whether reproductive health education courses should be permitted within the school curriculum, whether they should be obligatory or elective, if there should be separate courses or integration of fertility-related material into existing courses, and whether the sexes should be separated for instruction. There is awareness that formal sex education programs in a school setting cannot reach the large number of adolescents outside the educational system, but laws regarding public dissemination of reproductive health information are often restrictive. Contraceptive-related law and policy affect who has access to contraception and under what conditions. Abortion law takes 2 different forms: those that establish the retionales on which a given pregnancy may be terminated and those that establish the formal procedural requirements that must be met. It is concluded that, overall, law and policy have
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This article presents the results of a participatory exploration of male attitudes towards sexual and reproductive health issues in Nicaragua. Nicaraguan culture views men in a machismo concept. The study examined the knowledge, attitudes and behavior of men in relation to the social construction of masculinity: sexuality, reproduction, and fatherhood. Employing 90 men from both rural and urban communities, attitudes towards sexuality, reproduction, abortion and fatherhood were discussed. Several insights were gathered from the research, which explains men's behavior. Thus, it was deemed imperative that in empowering women by promoting sexual and reproductive health among men would require challenging male hegemony and persuading men to participate in health promotion. However, the setting and application of a men's agenda for sexual health promotion should not result in the curtailment of services for women because funds are being reallocated to men, nor should it give men the opportunity to more subtle forms of domination and exploitation.
Cai, Hong-cai; Shang, Xue-jun; Huang, Yu-feng
Autosomal dominant polycystic kidney disease (ADPKD) is a most common inherited renal disease, about 50% with a family history, although the exact etiology not yet clear. To date, ADPKD, a multisystem disorder without effective preventive and therapeutic means, has been shown to be detrimental to human health. Recent studies show that severe oligoasthenozoospermia, necrospermia, immotile sperm, azoospermia, epididymal cyst, seminal vesicle cyst, and ejaculatory duct cyst found in male ADPKD patients may lead to male infertility, though the specific mechanisms remain unknown. Structural anomaly of spermatozoa, defect of polycystin, mutation of PKD genes, and micro-deletion of the AZF gene could be the reasons for the higher incidence of abnormal semen quality in male ADPKD patients. Assisted reproductive techniques can increase the chances of pregnancy, whereas the health of the offspring should be taken into consideration. This article presents an overview of reproductive issues concerning infertile male ADPKD patients from the perspective of the morbidity, pathophysiological mechanism, diagnosis, and management of the disease.
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An internationally agreed conceptual definition of reproductive health is applied to the development and testing of practical indicators for use in the community. Basic criteria are proposed for an interview-based tool to measure reproductive health -- as opposed to morbidity or mortality -- adapting methods from the health status measurement field. Proposed domains and indicators linked to the definition of reproductive health adopted at the International Conference on Population and Development (ICPD) should be comparable across and within diverse populations. Two sets of domains that describe reproductive health are recommended for further development and testing, seven domains that focus directly on health and six others that assess related areas of well-being. PMID:12077618
This study aims to identify analytical approaches to situate men in processes pertaining to reproductive health. We challenge the position that identifies them only as actors that can support improvements in the health of women and children. More recently there has been a concern over reshaping their role, as individuals who both reproduce and face risks to their reproductive organs, behaviors, and processes. One possibility for explaining men's presence in such processes is to identify their absence or presence as conditioning the consequences for women and children. The issue is to determine how they hamper or foster maternal health. A second possibility is to delve into the relational, social, and potentially conflictive nature of "sexualized" reproduction. This implies a new approach to the analysis of reproduction as a relational process, rather than as isolated events involving men and women, meanwhile recovering the respective specificities. The gender perspective is used to conceive of processes without denying the power dimension. Thus, a new approach is taken to sexuality, reproduction, and health in terms of interaction, in order to build clearer references with regard to the male population. We base our study on the approach attempting to build reflections on men as related to the dynamics of reproductive health.
Premkumar, Ashish; Nseyo, Onouwem; Jackson, Andrea V
Since the police-involved deaths of Michael Brown and Freddie Gray, activists have argued for connecting police violence with reproductive justice. We argue that systematic violence, including police violence, should be evaluated in relation to reproductive health outcomes of individual patients and communities. Beyond emphasizing the relationship between violence and health outcomes, both qualitative and epidemiologic data can be used by activists and caregivers to effectively care for individuals from socially marginalized communities.
The social model of disability has been fruitful in promoting human rights of people with disabilities, but has been associated with a downplaying of the health dimension of disability. Adequate accounts of disability should make space for medical, psychological, social, and political factors in the lives of people with disabilities. Disability is almost always connected to a health condition; civil rights law needs to be anchored in a robust definition of the protected class; failure to meet health needs constitutes an important aspect of the discrimination faced by people with disabilities.
Tonmyr, Lil; Blackstock, Cindy
This commentary highlights indigenous public health research from a special issue of the International Journal of Mental Health and Addiction dealing with child maltreatment, mental health, substance abuse and gambling. We focus on the emerging and growing research movement in Indigenous research through three important themes: 1) worldview and…
National Center for Farmworker Health, Inc., Austin, TX.
This document contains 10 short monographs on priority issues relevant to the health and well-being of migrant and seasonal farmworkers and their families. An introduction by Daniel Hawkins discusses the important role of migrant health centers in providing primary and preventive health care services to this disadvantaged and underserved…
Schuster, Mark A.; Chung, Paul J.; Vestal, Katherine D.
All children, even the healthiest, have preventive and acute health care needs. Moreover, a growing number of children are chronically ill, with preventive, acute, and ongoing care needs that may be much more demanding than those for healthy children. Because children are unable to care for themselves, their parents are expected to provide a range…
Reindollar, Richard H
prevent any stigmatization to patients unfortunately diagnosed with premature oocyte depletion, and I believe that the use of the diagnosis POI leaves the door open for the occurrence of reproductive function and for the 5 to 10% of 46,XX patients who may spontaneously become pregnant. However, the world literature reports only two women with Turner syndrome, hypergonadotropic amenorrhea, and streak ovaries who have ever become pregnant spontaneously after their diagnosis. It would be unfair to such women with Turner syndrome to give them the same hope for pregnancy as we do for women with 46,XX POI. Amenorrheic women with Turner syndrome truly have ovarian failure. Although I have adopted the term POI in this article for women with Turner syndrome, semantics are no substitute for honest, thorough, and compassionate counseling.
Vested, Anne; Giwercman, Aleksander; Bonde, Jens Peter; Toft, Gunnar
Environmental contaminants such as persistent organic pollutants (POPs) are man-made bioaccumulative compounds with long half-lives that are found throughout the world as a result of heavy use in a variety of consumer products during the twentieth century. Wildlife and animal studies have long suggested adverse effects of exposure to these compounds on human reproductive health, which, according to the endocrine disrupter hypothesis, are ascribed to the compounds’ potential to interfere with endocrine signaling, especially when exposure occurs during certain phases of fetal and childhood development. An extensive number of epidemiological studies have addressed the possible effects of exposure to POPs on male reproductive health, but the results are conflicting. Thus far, most studies have focused on investigating exposure and the different reproductive health outcomes during adulthood. Some studies have addressed the potential harmful effects of fetal exposure with respect to malformations at birth and/or reproductive development, whereas only a few studies have been able to evaluate whether intrauterine exposure to POPs has long-term consequences for male reproductive health with measurable effects on semen quality markers and reproductive hormone levels in adulthood. Humans are not exposed to a single compound at a time, but rather, to a variety of different substances with potential divergent hormonal effects. Hence, how to best analyze epidemiological data on combined exposures remains a significant challenge. This review on POPs will focus on current knowledge regarding the potential effects of exposure to POPs during fetal and childhood life and during adulthood on male reproductive health, including a critical revision of the endocrine disruption hypothesis, a comment on pubertal development as part of reproductive development and a comment on how to account for combined exposures in epidemiological research. PMID:24369135
In the US, when one of the two hospitals involved in a merger is a Catholic hospital, comprehensive reproductive health care tends to suffer. The Catholic Church forbids its hospitals from providing and making direct referrals for many reproductive health services (i.e., reversible contraception, infertility treatments, male and female sterilization, abortion, condoms for HIV prevention, and emergency contraception). These mergers are especially severe in small towns and rural areas. Several groups have formed to address this hidden crisis. In Troy, New York, a settlement was reached about 12 months after a law suit was filed against the conditions of a merger between a Catholic hospital and a nonsectarian hospital. After a long fight, the settlement essentially guaranteed that patients who are dependent on religious institutions obtain the contraceptive and sterilization services they need and want, but abortion services and referrals continued to be denied. The state of Montana considered the impact of a merger of a Catholic institution and a nonsectarian institution, yet continued availability of all reproductive health services was not guaranteed. The American Civil Liberties Union asked the Federal Trade Commission (FTC) to investigate the merger's impact on reproductive health care, since the merger created a monopoly on acute care in Great Falls. FTC took no action. Key factors to provision of reproductive health services other than abortion in cases of mergers between a Catholic hospital and a nonsectarian hospital include the type of association the two hospitals enter into, the local bishop's willingness to accept a creative solution, and the willingness of the state to consider the implications of such a merger and take steps to guarantee the continued availability of services. State reproductive health care advocacy groups (e.g., MergerWatch in New York) are increasing public awareness of the risks these mergers pose and helping residents ensure that
Smith, Peggy B; Buzi, Ruth S
The purpose of this study was to assess reproductive health professionals' familiarity with and use of various electronic technologies to support health promotion. The study also examined the relationship between demographic characteristics and attitudes and beliefs of the effectiveness of new technologies and perceived barriers for usage. A total of 165 reproductive health professionals at two conferences related to reproductive health in the United States completed the study survey. Personal and organizational factors affected the adoption of electronic technologies for health promotion. This included lack of knowledge, skills, and confidence as well as privacy concerns. The results of the study also suggested that being from an older generation was associated with having lower levels of knowledge, skills, and confidence in using new media. These findings highlight the importance of creating learning opportunities on the use of new technology for health promotion as well as addressing specific perceived barriers among reproductive health professionals in order to promote the adoption of these technologies.
Feng, Wang; Ren, Ping; Shaokang, Zhan; Anan, Shen
As the largest labour flow in human history, the recent rise in migration in China has opened up unprecedented opportunities for millions of Chinese to rearrange their lives. At the same time, this process has also posed great challenges to Chinese migrants, especially female migrants, who not only face a bias against 'outsiders' but also have a greater need for reproductive health-related services in their migratory destinations. Based on data collected via multiple sources in Shanghai, China's largest metropolis, this study profiles the changing characteristics of female migrants, presents data on self-reported symptoms of reproductive health-related problems and knowledge on reproductive health issues, compares maternal and child health measures between migrants and local residents, and examines factors related to reproductive health knowledge and migrants' access to health care in urban China. Results of this study show a relatively low level of self-reported reproductive health problems among female migrants, coupled with a relatively high level of ignorance in knowledge related to STD. Both self-reported health status and knowledge of reproductive health are related to migrants' educational attainment and length of stay in the urban destination. This study also finds ample evidence that female migrants' access to urban health care is limited by a number of institutional barriers.
Lennane, K J
OBJECTIVE--To examine the response of organizations to "whistleblowing" and the effects on individual whistleblowers. DESIGN--Questionnaire survey of whistleblowers who contacted Whistleblowers Australia after its publicity campaign. SETTING--Australia. SUBJECTS--25 men and 10 women from various occupations who had exposed corruption or danger to the public, or both, from a few months to over 20 years before. RESULTS--All subjects in this non-random sample had suffered adverse consequences. For 29 victimization had started immediately after their first, internal, complaint. Only 17 approached the media. Victimization at work was extensive: dismissal (eight subjects), demotion (10), and resignation or early retirement because of ill health related to victimization (10) were common. Only 10 had a full time job. Long term relationships broke up in seven cases, and 60 of the 77 children of 30 subjects were adversely affected. Twenty nine subjects had a mean of 5.3 stress related symptoms initially, with a mean of 3.6 still present. Fifteen were prescribed long term treatment with drugs which they had not been prescribed before. Seventeen had considered suicide. Income had been reduced by three quarters or more for 14 subjects. Total financial loss was estimated in hundreds of thousands of Australian dollars in 17. Whistleblowers received little or no help from statutory authorities and only a modest amount from workmates. In most cases the corruption and malpractice continued unchanged. CONCLUSION--Although whistleblowing is important in protecting society, the typical organisational response causes severe and longlasting health, financial, and personal problems for whistleblowers and their families. PMID:8401056
Sexuality and power relations based on gender are relevant to researchers, policymakers, and service providers in the reproductive health field, because they underlie virtually all of the behaviors and conditions that their programs address. Yet, a review of conventional treatments in the demographic and family planning literature reveals that, when they consider these topics at all, researchers typically adopt narrow definitions of sexual behavior and focus almost exclusively on risks of pregnancy and disease. This article proposes an analytic framework as a guide to researchers and family planning providers. It relates four dimensions of sexuality to reproductive health outcomes and concludes that family planning policies and programs should address a broader spectrum of sexual behaviors and meanings, consider questions of sexual enjoyment as well as risk, and confront ideologies of male entitlement that threaten women's sexual and reproductive rights and health.
Lush, L.; Cleland, J.; Walt, G.; Mayhew, S.
Since 1994, integrating human immunodeficiency virus/sexually transmitted disease (HIV/STD) services with primary health care, as part of reproductive health, has been advocated to address two major public health problems: to control the spread of HIV; and to improve women's reproductive health. However, integration is unlikely to succeed because primary health care and the political context within which this approach is taking place are unsuited to the task. In this paper, a historical comparison is made between the health systems of Ghana, Kenya and Zambia and that of South Africa, to examine progress on integration of HIV/STD services since 1994. Our findings indicate that primary health care in Ghana, Kenya and Zambia has been used mainly by women and children and that integration has meant adding new activities to these services. For the vertical programmes which support these services, integration implies enhanced collaboration rather than merged responsibility. This compromise between comprehensive rhetoric and selective reality has resulted in little change to existing structures and processes; problems with integration have been exacerbated by the activities of external donors. By comparison, in South Africa integration has been achieved through political commitment to primary health care rather than expanding vertical programmes (top-down management systems). The rhetoric of integration has been widely used in reproductive health despite lack of evidence for its feasibility, as a result of the convergence of four agendas: improving family planning quality; the need to improve women's health; the rapid spread of HIV; and conceptual shifts in primary health care. International reproductive health actors, however, have taken little account of political, financial and managerial constraints to implementation in low-income countries. PMID:10534902
Cantonwine, David E.; Hauser, Russ; Meeker, John D.
Summary Bisphenol A (BPA) is a high production volume chemical with adverse endocrine and reproductive health effects in toxicological studies. Despite widespread general population exposure to BPA, knowledge of its potential impacts upon reproduction and pregnancy in humans is limited. This paper reviews the current epidemiological literature on fertility and adverse pregnancy outcomes associated with BPA exposure. It also provides relevant resources for health care providers who are in a unique position to provide guidance in reducing exposure to this endocrine disrupting chemical. PMID:24187577
Parsons, L; Goodwin, M M; Petersen, R
Since a large proportion of U.S. women receive reproductive health care services each year, reproductive health care settings offer an important opportunity to reach women who may be at risk of or experiencing intimate partner violence (IPV). Although screening women for IPV in clinical health care settings has been endorsed by national professional associations and organizations, scientific evidence suggests that opportunities for screening in reproductive health care settings are often missed. This commentary outlines what is known about screening and intervention for IPV in clinical health care settings, and points out areas that need greater attention. The ultimate goal of these recommendations is to increase the involvement of reproductive health care services in sensitive, appropriate, and effective care for women who may be at risk of or affected by IPV.
Mba, C I; Obi, S N; Ozumba, B C
This intervention study was to evaluate the impact of reproductive health education on the knowledge and attitude of adolescents in a rural Nigerian community to reproductive health issues. It compared adolescents in a secondary school (study group), which received health education on reproductive health with another secondary school (control group), which did not receive any. The impact of the programme was evaluated with a pre-test baseline knowledge and post-test gain in the knowledge 6 weeks later, using the same questionnaire. A total of 180 students selected by systematic sampling from each of the two randomly selected schools in Item, a rural community in south-east Nigeria participated in the programme. While all the respondents have heard of reproductive health and could identify at least one of its components, their knowledge of it prior to the health education were defective and were obtained mainly from peers and the mass media. Such information was incomplete and often coloured with cultural and religious bias. However, there was a significant (p < 0.05) gain in correct knowledge following the health education. The students in the study group showed a positive and permissive attitude towards reproductive health education and there was a drop in risky sexual behaviour following the intervention. Pre-marital sex (94.3%), pregnancy prevention and abortion (88.5%) and sexually transmitted infections (82.8%) were common reproductive health problems raised by the students. Reproductive health education as part of the school curriculum will provide an effective means of improving knowledge and reducing reproductive health problems among adolescents in developing countries.
Toppari, J; Larsen, J C; Christiansen, P; Giwercman, A; Grandjean, P; Guillette, L J; Jégou, B; Jensen, T K; Jouannet, P; Keiding, N; Leffers, H; McLachlan, J A; Meyer, O; Müller, J; Rajpert-De Meyts, E; Scheike, T; Sharpe, R; Sumpter, J; Skakkebaek, N E
Male reproductive health has deteriorated in many countries during the last few decades. In the 1990s, declining semen quality has been reported from Belgium, Denmark, France, and Great Britain. The incidence of testicular cancer has increased during the same time incidences of hypospadias and cryptorchidism also appear to be increasing. Similar reproductive problems occur in many wildlife species. There are marked geographic differences in the prevalence of male reproductive disorders. While the reasons for these differences are currently unknown, both clinical and laboratory research suggest that the adverse changes may be inter-related and have a common origin in fetal life or childhood. Exposure of the male fetus to supranormal levels of estrogens, such as diethlylstilbestrol, can result in the above-mentioned reproductive defects. The growing number of reports demonstrating that common environmental contaminants and natural factors possess estrogenic activity presents the working hypothesis that the adverse trends in male reproductive health may be, at least in part, associated with exposure to estrogenic or other hormonally active (e.g., antiandrogenic) environmental chemicals during fetal and childhood development. An extensive research program is needed to understand the extent of the problem, its underlying etiology, and the development of a strategy for prevention and intervention. Images Figure 3. A Figure 3. B Figure 3. C Figure 3. D Figure 3. E Figure 3. F PMID:8880001
Benagiano, Giuseppe; d'Arcangues, Catherine; Harris Requejo, Jennifer; Schafer, Alessandra; Say, Lale; Merialdi, Mario
The Special Programme of Research in Human Reproduction (HRP), co-sponsored by the UNDP, UNFPA, WHO, and the World Bank, is celebrating 40 years of activities with an expansion of its mandate and new co-sponsors. When it began, in 1972, the main focus was on evaluating the acceptability, effectiveness, and safety of existing fertility-regulating methods, as well as developing new, improved modalities for family planning. In 1994, HRP not only made major contributions to the Plan of Action of the International Conference on Population and Development (ICPD); it also broadened its scope of work to include other aspects of health dealing with sexuality and reproduction, adding a specific perspective on gender issues and human rights. In 2002, HRP's mandate was once again broadened to include sexually transmitted infections and HIV/AIDS and in 2003 it was further expanded to research activities on preventing violence against women and its many dire health consequences. Today, the work of the Programme includes research on: the sexual and reproductive health of adolescents, women, and men; maternal and perinatal health; reproductive tract and sexually transmitted infections (including HIV/AIDS); family planning; infertility; unsafe abortion; sexual health; screening for cancer of the cervix in developing countries, and gender and reproductive rights. Additional activities by the Programme have included: fostering international cooperation in the field of human reproduction; the elaboration of WHO's first Global Reproductive Health Strategy; work leading to the inclusion of ICPD's goal 'reproductive health for all by 2015' into the Millennium Development Goal framework; the promotion of critical interagency statements on the public health, legal, and human rights implications of female genital mutilation and gender-biased sex selection. Finally, HRP has been involved in the creation of guidelines and tools, such as the 'Medical eligibility criteria for contraceptive use
Covelli, Nicholas J.; And Others
A study was conducted to identify the trends occurring within the health service industry and their impact on the providers of health care; determine shifts or emerging occupational areas within health services; and assess local health service providers' staffing patterns and anticipated needs. The study involved meetings with local hospital…
Jennings, R T; Baker, E S
Women have been an integral part of United States space crews since the initial flight of Dr. Sally Ride in 1983, and a total of 40 women have been selected as U.S. astronauts. This article examines the reproductive and gynecological aspects of selecting, training, medically certifying, and flying women in space. Gynecological data from the astronaut selection cycles in 1991 to 1997 are reviewed. In addition, the reproductive implications of delaying childbearing for a career as an astronaut and the impact of new technology such as assisted reproductive techniques are examined. The reproductive outcomes of U.S. female astronauts after spaceflight are also presented. Because women have gained considerable operational experience on the Shuttle and Mir, the unique operational considerations for preflight certification, menstruation control and hygiene, contraception, and urination are discussed. Medical and surgical implications for women on long-duration missions to remote locations are still evolving, and enabling technologies for health care delivery are being developed. There has been considerable progress in the development of zero-gravity surgical techniques, including laparoscopy, thoracoscopy, and laparotomy. The concepts of prevention of illness, conversion of surgical conditions to medically treatable conditions, and surgical intervention for long-duration spaceflights are explored in detail. There currently are no operational gynecological or reproductive constraints for women that would preclude their successful participation in the exploration of our nearby solar system.
A substantial database exists on the inhalation toxicity of MTBE, but exposure information and health effects data for non-inhalation routes of exposure are limited. In addition, several issues complicate the interpretation of the avaialble data in assessing the healt risks of M...
Santa Maria, Diane; Guilamo-Ramos, Vincent; Jemmott, Loretta Sweet; Derouin, Anne; Villarruel, Antonia
: Nurses care for adolescents in a variety of settings, including communities, schools, and public health and acute care clinics, which affords them many opportunities to improve adolescents' sexual and reproductive health and reduce the rates of unplanned pregnancy and sexually transmitted infections. To ensure that adolescents have access to sexual and reproductive health care (which includes both preventive counseling and treatment) in all nursing practice sites, nurses need to gain the knowledge and hone the skills required to deliver evidence-based counseling and services to adolescents and parents. Collectively, nurses can use their unique combination of knowledge and skills to make a positive impact on adolescent sexual and reproductive outcomes. Nurses have the capacity and opportunity to disseminate information about sexual and reproductive health to adolescents and their parents in communities, schools, public health clinics, and acute care settings. This article discusses the Society for Adolescent Health and Medicine's goals and recommendations, which address adolescent sexual and reproductive health as both a health care and a human rights issue.
Jahnke, Gloria D; Choksi, Neepa Y; Moore, John A; Shelby, Michael D
A thyroid toxicant workshop sponsored by the National Toxicology Program Center for the Evaluation of Risks to Human Reproduction convened on 28-29 April 2003 in Alexandria, Virginia. The purpose of this workshop was to examine and discuss chemical-induced thyroid dysfunction in experimental animals and the relevance of reproductive and developmental effects observed for prediction of adverse effects in humans. Presentations highlighted and compared reproductive and developmental effects of thyroid hormones in humans and rodents. Rodent models of thyroid system dysfunction were presented. Animal testing protocols were reviewed, taking into account protocol designs that allow extrapolation to possible human health effects. Potential screening methods to assess toxicant-induced thyroid dysfunction were outlined, and postnatal bioassays of thyroid-related effects were discussed. PMID:14998754
In the past few years a growing interest in vitamin D can be observed in the lay and biomedical literature due to findings demonstrating a low vitamin D status in the population. In addition to its importance for the regulation of calcium and phosphorus homeostasis recent epidemiologic studies have observed relationships between low vitamin D levels and multiple disease states. This secosteroid hormone also regulates the expression of a large number of genes in reproductive tissues implicating a role for vitamin D in female reproduction. In this report we summarize the recent evidence that vitamin D status influences female reproductive and pregnancy outcomes. Human and animal data suggest that low vitamin D status is associated with impaired fertility, endometriosis and polycystic ovary syndrome. Evidence from observational studies shows higher rates of preeclampsia, preterm birth, bacterial vaginosis and gestational diabetes in women with low vitamin D levels. However, confirmation of experimental observations establishing an association of vitamin D deficiency with adverse reproductive outcomes by high quality observational and large-scale randomized clinical trials is still lacking. The determination of optimal 25(OH)D3 levels in the reproductive period and the amount of vitamin D supplementation required to achieve those levels for the numerous actions of vitamin D throughout a woman's life would have important public health implications. PMID:22047005
In 1995 the IPPF Africa Region undertook advocacy missions to six countries in the region to sensitize national leaders about family planning (FP). This mission was governed by the six challenges laid down in the IPPF's strategic plan, Vision 2000, and the program of action of the International Conference on Population and Development (ICPD) held in Cairo in 1994. In Ethiopia, Kenya, and Tanzania the concerns were adolescent sexuality, family life education, and services to youth. In Uganda unsafe abortion; while in the Central African Republic and Guinea sexual and reproductive health, unsafe abortion, the sexuality of youth, and the empowerment of women were the main issues. Documentation packages prepared for the mission included annual reports, periodicals, conference reports, booklets, and position papers. The target audiences were political leaders, national, regional, and international organizations, religious, educational, and media leaders, and the public. Press conferences were organized and lobbying was conducted with national family planning associations to strengthen networking and coalition building. In Ethiopia the IPPF president's visit pertained to the sexuality of young people. In Kenya the mission coincided with the controversy of introducing family life education in primary schools. A seminar in Nairobi brought together 100 influential people who came to an agreement on the necessity of such education. In Tanzania the advocacy team crusaded for reproductive health services for young people. The country's president fully supported FP activities even allowing the use of hospitals and health centers for the distribution of contraceptives. There was a visit to a teenage mothers' center providing vocational training and reproductive health counseling in Dar es Salaam. In Uganda UNFPA, USAID, and national family planning association representatives met to forge closer working relations and examine the issue of tax exemption for imported contraceptives
Background The Inter-agency Working Group on Reproductive Health in Crises conducted a ten-year global evaluation of reproductive health in humanitarian settings. This paper examines proposals for reproductive health activities under humanitarian health and protection funding mechanisms for 2002-2013, and the level at which these reproductive health proposals were funded. Methods The study used English and French health and protection proposal data for 2002-2013, extracted from the Financial Tracking Service (FTS) database managed by the United Nations Office for the Coordination of Humanitarian Affairs. Every project was reviewed for relevance against pre-determined reproductive health definitions for 2002-2008. An in-depth analysis was additionally conducted for 2009-2013 through systematically reviewing proposals via a key word search and subsequently classifying them under designated reproductive health categories. Among the relevant reproductive health proposals, counts and proportions were calculated in Excel based on their reproductive health components, primarily by year. Contributions, requests, and unfunded requests were calculated based on the data provided by FTS. Results Among the 11,347 health and protection proposals issued from 345 emergencies between 2002 and 2013, 3,912 were relevant to reproductive health (34.5%). The number of proposals containing reproductive health activities increased by an average of 21.9% per year, while the proportion of health and protection sector appeals containing reproductive health activities increased by an average of 10.1% per year. The total funding request over the 12 years amounted to $4.720 billion USD, of which $2.031 billion USD was received. Among reproductive health components for 2009-2013 proposals, maternal newborn health comprised the largest proportion (56.4%), followed by reproductive health-related gender-based violence (45.9%), HIV/sexually transmitted infections (37.5%), general reproductive health
Penchaszadeh, V B
New reproductive genetics means recently developed techniques to prevent the birth of children with specific defects or genetic diseases by testing individuals for sickle cell anemia, the thalassemias, Tay-Sachs disease, cystic fibrosis, or Down syndrome. Third World health services have many deficiencies with high maternal mortality rates (30-40 fold higher than in developed countries), the low percentage of births delivered by health personnel, the high rates of low birth weight babies, and high child malnutrition and infant mortality rates. The main issues in women's reproductive health are fertility regulation, abortion, maternal mortality, sexually transmitted diseases, and infertility. As a result of expansion in contraceptive use worldwide, the total fertility rate in developing countries has declined from 6.1 in 1965 to 3.9 in 1990. It is estimated that, worldwide, 36-53 million induced abortions are performed each year, most of them in developing nations. WHO estimates that more than 500,000 women die each year because of complications of pregnancy, most in developing countries. More than 95% of the 13 million estimated deaths of children under 5 years of age have occurred in these countries. Approximately 200 million people carry a potentially pathologic hemoglobinopathy gene, and about 250,000 children are born every year with hemoglobinopathy, most of them in the developing world. Reproductive genetic testing in big cities and in private for-profit ventures cater to the socioeconomic elite. Amniocentesis is often misused for fetal sex determination to abort female fetuses in India. Currently, in Cuba virtually every pregnant woman is tested for sickle cell trait and maternal serum alpha-fetoprotein levels between 15 and 20 weeks of gestation. It is predicted that the judicious use of reproductive genetic testing will be possible when health and quality of life issues are addressed properly.
Sen, Gita; Govender, Veloshnee
Sexual and reproductive health and rights (SRHR) are centrally important to health. However, there have been significant shortcomings in implementing SRHR to date. In the context of health systems reform and universal health coverage/care (UHC), this paper explores the following questions. What do these changes in health systems thinking mean for SRHR and gender equity in health in the context of renewed calls for increased investments in the health of women and girls? Can SRHR be integrated usefully into the call for UHC, and if so how? Can health systems reforms address the continuing sexual and reproductive ill health and violations of sexual and reproductive rights (SRR)? Conversely, can the attention to individual human rights that is intrinsic to the SRHR agenda and its continuing concerns about equality, quality and accountability provide impetus for strengthening the health system? The paper argues that achieving equity on the UHC path will require a combination of system improvements and services that benefit all, together with special attention to those whose needs are great and who are likely to fall behind in the politics of choice and voice (i.e., progressive universalism paying particular attention to gender inequalities). PMID:25536851
Shah, Brandi; Chan, Serena H.; Perriera, Lisa; Gold, Melanie A.; Akers, Aletha Y.
OBJECTIVE Delivery of reproductive services to adolescents varies by specialty and has been linked to differences in clinical training. Few studies have explored how different specialties’ graduate medical education (GME) programs prepare providers to deliver adolescent reproductive services. We explored the perceptions of resident physicians regarding their training in delivering adolescent reproductive health services. DESIGN Between November 2008 and February 2009, nine focus groups were conducted with graduate medical trainees in three specialties that routinely care for adolescents. The semi-structured discussions were audio-recorded, transcribed and analyzed using an inductive approach to content analysis. SETTING Large, urban academic medical center in Pittsburgh, Pennsylvania PARTICIPANTS 54 resident trainees in pediatrics, family medicine and obstetrics/gynecology INTERVENTIONS None MAIN OUTCOMES Trainees’ perspectives regarding the didactic teaching and clinical training in providing adolescent reproductive services RESULTS Five themes emerged reflecting trainees’ beliefs regarding the best practices GME programs can engage in to ensure that trainees graduate feeling competent and comfortable delivering adolescent reproductive services. Trainees believed programs need to: 1) Provide both didactic lectures as well as diverse inpatient and outpatient clinical experiences; 2) Have faculty preceptors skilled in providing and supervising adolescent reproductive services; 3) Teach skills for engaging adolescents in clinical assessments and decision-making; 4) Train providers to navigate confidentiality issues with adolescents and caregivers; and 5) Provide infrastructure and resources for delivering adolescent reproductive services. CONCLUSIONS The three specialties differed in how well each of the five best practices were reportedly addressed during GME training. Policy recommendations are provided. PMID:26542014
Tsang, Anna; Moriarty, Carmel; Towns, Susan
With survival now into the fourth decade and rapid growth of the adolescent and adult population of people with cystic fibrosis CF sexual and reproductive health issues are integral to the management of adolescents and adults with CF. Education and counseling for sexual health related issues must be included in the daily routine of CF care. With advances in genetic counseling, contraception, assisted reproductive technology and collaborative management adolescents and young adults with CF realizing their sexual and reproductive potentials safely and realistically can be possible .
Downs, Julie S.; Arslanian, Silva; de Bruin, Wändi Bruine; Copeland, Valire Carr; Doswell, Willa; Herman, William; Lain, Kristine; Mansfield, Joan; Murray, Pamela J.; White, Neil; Charron-Prochownik, Denise
Purpose The purpose of this article was to summarize scientific knowledge from an expert panel on reproductive health among adolescents with type 2 diabetes (T2D). Methods Using a mental model approach, a panel of experts—representing perspectives on diabetes, adolescents, preconception counseling, and reproductive health—was convened to discuss reproductive health issues for female adolescents with T2D. Results Several critical issues emerged. Compared with adolescents with type 1 diabetes, (1) adolescents with T2D may perceive their disease as less severe and have less experience managing it, putting them at risk for complications; (2) T2D is more prevalent among African Americans, who may be less trusting of the medical establishment; (3) T2D is associated with obesity, and it is often difficult to change one’s lifestyle within family environments practicing sedentary and dietary behaviors leading to obesity; (4) teens with T2D could be more fertile, because obesity is related to earlier puberty; (5) although obese teens with T2D have a higher risk of polycystic ovary syndrome, which is associated with infertility, treatment with metformin can increase fertility; and (6) women with type 2 diabetes are routinely transferred to insulin before or during pregnancy to allow more intensive management. Conclusions Findings from the expert panel provide compelling reasons to provide early, developmentally appropriate, culturally sensitive preconception counseling for teens with T2D. PMID:20944055
Bunkar, Neha; Pathak, Neelam; Lohiya, Nirmal Kumar
It is well established that there is a heritable element of susceptibility to chronic human ailments, yet there is compelling evidence that some components of such heritability are transmitted through non-genetic factors. Due to the complexity of reproductive processes, identifying the inheritance patterns of these factors is not easy. But little doubt exists that besides the genomic backbone, a range of epigenetic cues affect our genetic programme. The inter-generational transmission of epigenetic marks is believed to operate via four principal means that dramatically differ in their information content: DNA methylation, histone modifications, microRNAs and nucleosome positioning. These epigenetic signatures influence the cellular machinery through positive and negative feedback mechanisms either alone or interactively. Understanding how these mechanisms work to activate or deactivate parts of our genetic programme not only on a day-to-day basis but also over generations is an important area of reproductive health research. PMID:27358824
Canobbio, M M
The number of children with congenital heart disease surviving beyond adolescence is rapidly increasing. Consequently, pediatric health providers not only have to address medical issues associated with the cardiac condition but must begin to develop programs that assist adolescents and their families in dealing with special health care needs for the young patient to successfully move into the adult world. Transitional health-related issues facing the adolescent with congenital heart disease including medical follow-up, insurability, employability, sexuality, and reproduction are described. Discussion about advising and counseling both patient and parents is included.
This workgroup report addresses the central question: what are the critical windows during development (pre-conception through puberty) when exposure to xenobiotics may have the greatest adverse impact on subsequent reproductive health. The reproductive system develops in stages...
Arousell, Jonna; Carlbom, Aje
An increasing number of contemporary research publications acknowledge the influence of religion and culture on sexual and reproductive behavior and health-care utilization. It is currently hypothesized that religious influences can partly explain disparities in sexual and reproductive health outcomes. In this paper, we will pay particular attention to Muslims in sexual and reproductive health care. This review reveals that knowledge about devout Muslims' own experience of sexual and reproductive health-care matters is limited, thus providing weak evidence for modeling of efficient practical guidelines for sexual and reproductive health care directed at Muslim patients. Successful outcomes in sexual and reproductive health of Muslims require both researchers and practitioners to acknowledge religious heterogeneity and variability, and individuals' possibilities to negotiate Islamic edicts. Failure to do so could lead to inadequate health-care provision and, in the worst case, to suboptimal encounters between migrants with Muslim background and the health-care providers in the receiving country.
Pinkerton, JoAnn V; Stovall, Dale W
Changes in ovarian hormone production may affect numerous health outcomes including vasomotor symptoms, cardiovascular disease (CVD), osteoporosis, cognition, depression, mood disorders, sexual function, and vaginal atrophy. We will compare age-related changes to those associated with reproductive aging and menopause and the effects of estrogen therapy on selected health outcomes. Hormone therapy (HT) reduces frequency and severity of hot flashes, prevents bone loss and osteoporotic fractures, and relieves vaginal atrophy. Nonhormone therapy trials with antidepressants or gabapentin for hot flash relief are promising. To date, clinical trial data are insufficient to recommend the use of HT for prevention or treatment of CVD, mood disorders, cognition, or sleep disorders. For some disease states, such as CVD and cognition, a "critical time window" has been proposed but not proven, such that estrogen use early in the menopause transition may be beneficial while estrogen use later in life would lead to increased health risks.
The Tanzania Media Women's Association (TAMWA) is a nongovernmental organization of female journalists who wish to better the status of Tanzanian women via the mass media, particularly radio and television. Their main objective is to promote and disseminate information on women's health. 51% of the population of Tanzania are women. These women are the main producers of food and cash crops. Women, even during pregnancy, work 18 hours a day in the field; men work 3 to 6 hours. Since male children are given preference for food, girls are often underdeveloped when they reach puberty and about 80% of pregnant Tanzanian women are anemic. Health programs are geared for mothers only. TAMWA uses mainstream media to remedy these problems. Mazungumza baada ya habari, a 5-minute editorial program on Radio Tanzania, is often used to discuss women's issues. Sauti ya Siti, a magazine, is produced by TAMWA to educate women about health issues and strategies to improve their daily lives. Brochures containing information on reproductive health are distributed to villages, schools, and colleges. In association with the Medical Women's Association of Tanzania (MEWATA), TAMWA holds an annual (May 28) community meeting of women, experts, and politicians to discuss problems in women's health and possible solutions. The results of these meetings are later published by TAMWA. An ongoing research program monitors the incidence of rape, abortion, maternal mortality, and other issues of interest. A major review of laws affecting reproductive health is underway. Since the media is male oriented and prohibited from taking an assertive public policy role, traditional structures need to be challenged to advance the status of women in Africa. Public opinion, as well as the law, must change.
This article opens by tabulating selected family planning (FP) indicators from the 24 poorest countries (those with a gross national product (GNP) of up to $300 per capita). Consideration of what is poverty and who are the poor concludes that poverty is hard to define but that is it a combination of low income, low life expectancy, illiteracy, and low educational levels; that is, the result of a denial of choices and opportunities. The poorest countries by this criteria differ somewhat from the poorest chosen according to GNP, but most are located in sub-Saharan Africa. The use of national data is complicated by the fact that huge differences exist between rich and poor within countries. The poorest countries have the lowest use of FP, the most restrictive abortion laws, high incidences of mortality associated with unsafe abortion, and high maternal mortality rates. International population and FP assistance is embarrassingly low and unfairly allocated. International assistance must be increased to break the cycle of poverty and improve reproductive health. The International Planned Parenthood Federation (IPPF) believes that improvement of reproductive health for the impoverished is a basic condition for human development and reduction of global inequity. In its policy statement on this topic, the IPPF recommends that local FP associations 1) constantly reevaluate how to maximize their impact on the most vulnerable, 2) be pioneers in the field of sexual and reproductive health, 3) reassess priorities in light of diminishing donor funding, 4) become advocates for increased resources and to further the work they are undertaking, and 5) strengthen collaboration with other development agencies working in the field.
Public speculation about bioterrorism and the increasing obesity epidemic are examples of current public health issues that continue to be illuminated in the spotlight. Major public health threats continue to drive the health job market and impact higher education health curricula (e.g., public health, health promotion, community health). Also,…
Mee, J F
The objective of this review is to address the reproductive issues arising from different dairy management systems by describing divergent systems and comparing their reproductive outcomes. The increasing global demand for dairy products has led to the majority of the world's milk being produced in intensive management systems. This intensification has occurred in both zero-grazed (ZG) and in pasture-based (PB) systems, and it has contributed directly to the current decline in dairy cow fertility globally. Given the heterogeneous nature of both ZG and PB systems, comparisons between them in dairy cow reproductive performance need to be treated with caution. In general, cows in ZG systems have higher milk production and better energy balance but more of some animal health problems, lower ovarian activity post-partum, reduced oestrous expression, reduced conception success, and higher culling and mortality rates, than cows in PB systems. Key environmental descriptors affecting reproductive performance within management systems include the type and duration of housing and the pre- and post-partum diet composition. Genetic by environment (GxE) interactions for dairy cow fertility have been detected for some, but not for other, management systems. Given the concerns of some consumers within the EU about the health, fertility and welfare of dairy cows in modern dairy herd management systems, there is a need to address these concerns with large-scale experimental and epidemiological studies.
Tadmouri, Ghazi O; Nair, Pratibha; Obeid, Tasneem; Al Ali, Mahmoud T; Al Khaja, Najib; Hamamy, Hanan A
Consanguineous marriages have been practiced since the early existence of modern humans. Until now consanguinity is widely practiced in several global communities with variable rates depending on religion, culture, and geography. Arab populations have a long tradition of consanguinity due to socio-cultural factors. Many Arab countries display some of the highest rates of consanguineous marriages in the world, and specifically first cousin marriages which may reach 25-30% of all marriages. In some countries like Qatar, Yemen, and UAE, consanguinity rates are increasing in the current generation. Research among Arabs and worldwide has indicated that consanguinity could have an effect on some reproductive health parameters such as postnatal mortality and rates of congenital malformations. The association of consanguinity with other reproductive health parameters, such as fertility and fetal wastage, is controversial. The main impact of consanguinity, however, is an increase in the rate of homozygotes for autosomal recessive genetic disorders. Worldwide, known dominant disorders are more numerous than known recessive disorders. However, data on genetic disorders in Arab populations as extracted from the Catalogue of Transmission Genetics in Arabs (CTGA) database indicate a relative abundance of recessive disorders in the region that is clearly associated with the practice of consanguinity. PMID:19811666
Salinas-Martínez, A M; Martinez-Sanchez, C; Perez-Segura, J
Educational interventions represent an alternative for the reproductive well-being. The objective of this investigation was to identify in a mexican community, attitudes and behaviors related to reproductive health, with the goal of implementing a specific health education program. The study population consisted of women between 12 and 44 years old, living in non-residential areas of the Delegation Miguel Hidalgo, D.F. Variables of interest were analyzed only in women with parity (n = 300). Data were collected through interview. The mean age was 31 +/- 8 years. 93.3% were married or in consensual union. 63% had elementary, junior high or prevocational studies. 89% answered that would visit the doctor before considering a pregnancy (junior high+, p < .05), 99% would seek prenatal care if they were pregnant, and 92.7% would have a hospital delivery (parity < or = 3, p < .003). 69.5% had a preconceptional visit before their last pregnancy and 89.9% received prenatal care (junior high+, p < .008). 92.5% had only hospital deliveries (< or = 30 years, p < .05, junior high+, p < .0001, primigravida p < .002, with institutionalized medical services, p < .001), 1.7% had only out-of-hospital deliveries, and 5.8% both. Agreement between attitudes and behaviors are presented. An educational program consisting of confirmation and support to positive attitudes, values and beliefs, and reinforcement to decision making, will result in a final behavior: early assistance to medical care.
Harper, Joyce C; Geraedts, Joep; Borry, Pascal; Cornel, Martina C; Dondorp, Wybo; Gianaroli, Luca; Harton, Gary; Milachich, Tanya; Kääriäinen, Helena; Liebaers, Inge; Morris, Michael; Sequeiros, Jorge; Sermon, Karen; Shenfield, Françoise; Skirton, Heather; Soini, Sirpa; Spits, Claudia; Veiga, Anna; Vermeesch, Joris Robert; Viville, Stéphane; de Wert, Guido; Macek, Milan
In March 2005, a group of experts from the European Society of Human Genetics and European Society of Human Reproduction and Embryology met to discuss the interface between genetics and assisted reproductive technology (ART), and published an extended background paper, recommendations and two Editorials. Seven years later, in March 2012, a follow-up interdisciplinary workshop was held, involving representatives of both professional societies, including experts from the European Union Eurogentest2 Coordination Action Project. The main goal of this meeting was to discuss developments at the interface between clinical genetics and ARTs. As more genetic causes of reproductive failure are now recognised and an increasing number of patients undergo testing of their genome before conception, either in regular health care or in the context of direct-to-consumer testing, the need for genetic counselling and preimplantation genetic diagnosis (PGD) may increase. Preimplantation genetic screening (PGS) thus far does not have evidence from randomised clinical trials to substantiate that the technique is both effective and efficient. Whole-genome sequencing may create greater challenges both in the technological and interpretational domains, and requires further reflection about the ethics of genetic testing in ART and PGD/PGS. Diagnostic laboratories should be reporting their results according to internationally accepted accreditation standards (International Standards Organisation – ISO 15189). Further studies are needed in order to address issues related to the impact of ART on epigenetic reprogramming of the early embryo. The legal landscape regarding assisted reproduction is evolving but still remains very heterogeneous and often contradictory. The lack of legal harmonisation and uneven access to infertility treatment and PGD/PGS fosters considerable cross-border reproductive care in Europe and beyond. The aim of this paper is to complement previous publications and
Padmanabhan, V; Veiga-Lopez, A
Inappropriate programming of the reproductive system by developmental exposure to excess steroid hormones is of concern. Sheep are well suited for investigating developmental origin of reproductive and metabolic disorders. The developmental time line of female sheep (approximately 5 mo gestation and approximately 7 mo to puberty) is ideal for conducting sequential studies of the progression of metabolic and/or reproductive disruption from the developmental insult to manifestation of adult consequences. Major benefits of using sheep include knowledge of established critical periods to target adult defects, a rich understanding of reproductive neuroendocrine regulation, availability of noninvasive approaches to monitor follicular dynamics, established surgical approaches to obtain hypophyseal portal blood for measurement of hypothalamic hormones, and the ability to perform studies in natural setting thereby keeping behavioral interactions intact. Of importance is the ability to chronically instrument fetus and mother for determining early endocrine perturbations. Prenatal exposure of the female to excess testosterone (T) leads to an array of adult reproductive disorders that include LH excess, functional hyperandrogenism, neuroendocrine defects, multifollicular ovarian morphology, and corpus luteum dysfunction culminating in early reproductive failure. At the neuroendocrine level, all 3 feedback systems are compromised. At the pituitary level, gonadotrope (LH secretion) sensitivity to GnRH is increased. Multifollicular ovarian morphology stems from persistence of follicles as well as enhanced follicular recruitment. These defects culminate in progressive loss of cyclicity and reduced fecundity. Prenatal T excess also leads to fetal growth retardation, an early marker of adult reproductive and metabolic diseases, insulin resistance, hypertension, and behavioral deficits. Collectively, the reproductive and metabolic deficits of prenatal T-treated sheep provide proof of
Moline, J M; Golden, A L; Bar-Chama, N; Smith, E; Rauch, M E; Chapin, R E; Perreault, S D; Schrader, S M; Suk, W A; Landrigan, P J
The discovery in the mid-1970s that occupational exposures to pesticides could diminish or destroy the fertility of workers sparked concern about the effects of hazardous substances on male reproductive health. More recently, there is evidence that sperm quantity and quality may have declined worldwide, that the incidence of testicular cancer has progressively increased in many countries, and that other disorders of the male reproductive tract such as hypospadias and cryptorchidism may have also increased. There is growing concern that occupational factors and environmental chemical exposures, including in utero and childhood exposures to compounds with estrogenic activity, may be correlated with these observed changes in male reproductive health and fertility. We review the evidence and methodologies that have contributed to our current understanding of environmental effects on male reproductive health and fertility and discuss the methodologic issues which confront investigators in this area. One of the greatest challenges confronting researchers in this area is assessing and comparing results from existing studies. We elaborate recommendations for future research. Researchers in the field of male reproductive health should continue working to prioritize hazardous substances; elucidate the magnitude of male reproductive health effects, particularly in the areas of testicular cancer, hypospadias, and cryptorchidism; develop biomarkers of exposure to reproductive toxins and of reproductive health effects for research and clinical use; foster collaborative interdisciplinary research; and recognize the importance of standardized laboratory methods and sample archiving. PMID:11017884
Kamath, Veena Ganesh; Kamath, Asha; Roy, Kallol; Rao, Chythra Raghavendra; Hegde, Asha; Ashok, Lena
In India it is taboo to discuss sexual and reproductive health (RH) issues, especially with adolescent boys. Minimal research has been done in India to address the adolescent mindset of boys. Our aim was to study the unaddressed issues among boys and to highlight their perspectives regarding RH.
Bhutta, Zulfiqar A; Lassi, Zohra S; Blanc, Ann; Donnay, France
Some interventions in women before and during pregnancy may reduce perinatal and neonatal deaths, and recent research has established linkages of reproductive health with maternal, perinatal, and early neonatal health outcomes. In this review, we attempted to analyze the impact of biological, clinical, and epidemiologic aspects of reproductive and maternal health interventions on perinatal and neonatal outcomes through an elucidation of a biological framework for linking reproductive, maternal and newborn health (RHMNH); care strategies and interventions for improved perinatal and neonatal health outcomes; public health implications of these linkages and implementation strategies; and evidence gaps for scaling up such strategies. Approximately 1000 studies (up to June 15, 2010) were reviewed that have addressed an impact of reproductive and maternal health interventions on perinatal and neonatal outcomes. These include systematic reviews, meta-analyses, and stand-alone experimental and observational studies. Evidences were also drawn from recent work undertaken by the Child Health Epidemiology Reference Group (CHERG), the interconnections between maternal and newborn health reviews identified by the Global Alliance for Prevention of Prematurity and Stillbirth (GAPPS), as well as relevant work by the Partnership for Maternal, Newborn and Child Health. Our review amply demonstrates that opportunities for assessing outcomes for both mothers and newborns have been poorly realized and documented. Most of the interventions reviewed will require more greater-quality evidence before solid programmatic recommendations can be made. However, on the basis of our review, birth spacing, prevention of indoor air pollution, prevention of intimate partner violence before and during pregnancy, antenatal care during pregnancy, Doppler ultrasound monitoring during pregnancy, insecticide-treated mosquito nets, birth and newborn care preparedness via community-based intervention
Peterson, M M
In Australia and other countries, certain groups of women have traditionally been denied access to assisted reproductive technologies (ARTs). These typically are single heterosexual women, lesbians, poor women, and those whose ability to rear children is questioned, particularly women with certain disabilities or who are older. The arguments used to justify selection of women for ARTs are most often based on issues such as scarcity of resources, and absence of infertility (in lesbians and single women), or on social concerns: that it "goes against nature"; particular women might not make good mothers; unconventional families are not socially acceptable; or that children of older mothers might be orphaned at an early age. The social, medical, legal, and ethical reasoning that has traditionally promoted this lack of equity in access to ARTs, and whether the criteria used for client deselection are ethically appropriate in any particular case, are explored by this review. In addition, the issues of distribution and just "gatekeeping" practices associated with these sensitive medical services are examined.
Nobelius, Ann-Maree; Kalina, Bessie; Pool, Robert; Whitworth, Jimmy; Chesters, Janice; Power, Robert
This paper defines how out-of-school adolescents from Masaka District in rural southwest Uganda currently receive sexual and reproductive health information and how they would prefer to receive that information. Information adolescents feel they lack falls into three broad categories: sexual and reproductive health issues, the negotiation of sex…
Assisted reproductive technologies (ART) have changed life for the past 25 years and many ethical and social issues have emerged following this new method of conception. In order to protect individuals against scientific and ethical abuses without inhibiting scientific progress, a specific legal framework is necessary. The first French law on Bioethics was voted after an extensive debate in 1994 then reviewed in 2004. This review previously scheduled every five years is currently being discussed. Legal provisions applying to ART are part of a large framework including the protection of the patients' rights and biomedical research. The key principles consist of respect for human life and ban on commercial practices of human body parts, eugenic practices and any kind of cloning. These key principles apply to ART. Donation is anonymous and free. Created in 2004, the Agence de la biomédecine is a government agency and one of the main tools of the French regulations. The missions focus on improving the quality and the safety of the management of ART. Evaluation of activities is available to all from the annual report. The agency represents the French competent authority for medical and scientific aspects of ART. Substantial differences in European legislations exist from the open-up "laissez faire" to the most restrictive one. As a consequence a large reproductive tourism has developed particularly for egg donation or surrogacy. The medical and ethical conditions of management of patients and donors represent the main critical points. In order to avoid ethical abuses, homogenization regarding the key principles is necessary in Europe. It is an opportunity to reassert that human body parts should not be a source of financial gain.
Health care will continue to occupy a prominent place in state legislative deliberations, as indicated by the National Conference of State Legislatures' 1987 State Issues Survey. The survey addressed state actions in these health issue areas: (1) health care for the medically indigent; (2) medical malpractice; (3) certificate of need and health…
Cook, Rebecca J; Cusack, Simone; Dickens, Bernard M
Stereotypes are generalized preconceptions defining individuals by group categories into which they are placed. Women have become stereotyped as homemakers and mothers, with the negative effect of precluding them from other roles and functions. Legislation and judicial constructions show a history, and often a continuing practice, of confining women to these stereotypical functions. In access to reproductive and sexual health care, for instance, women's requests have been professionally subject to approval of their husbands, fathers or comparable males. Choice of abortion is particularly significant, because it embeds moral values. Women's capacity to act as responsible moral agents is denied by stereotypical attitudes shown by legislators, judges, heads of religious denominations, and healthcare providers who consider women incapable of exercising responsible moral choice. These attitudes violate ethical requirements of treating patients with respect and equal justice. They can also result in violations of human rights laws that prohibit discrimination against women.
To help support and direct the Lions Club's construction of a Community Health Clinic specializing in Reproductive and Sexual Health, this descriptive study began in November of 2004 and was completed in May 2005. The sample consists of 552 high school students in Rumiñahui County, and surveys were used to study four principle themes: reproductive and sexual health education, family planning, sexually transmitted infections, and domestic violence. The results show a widespread lack of accurate and adequate information about reproductive and sexual health. Statistically significant variables studied include sex, age, monthly income, and age of first sexual experience. Female sex, younger age, lower monthly income, and younger age of first sexual experience all contribute to a lower quality of reproductive and sexual health, in terms of having less information about and access to these four aspects of reproductive and sexual health. PMID:18523623
Sauerbrun-Cutler, May-Tal; Segars, James H
Health disparities exist in reproductive medicine as discussed in detail in the subsequent articles of this issue; however, in most cases, the exact cause of these differences is unknown. Some of these disparities can be linked to environmental exposures such as alcohol and other hazardous toxic exposures (polycarbonate, pesticides, nicotine) in adults. In addition, low socioeconomic status, behavioral risk factors, and lack of education have been linked to poor obstetric and reproductive outcomes in minority groups. Aside from these various environmental exposures later in life, there is evidence that adverse events in utero could contribute to poor reproductive outcome in specific minority groups. We will focus on the developmental origins of health and disease as a possible causal mechanism for health disparities in reproductive diseases, as this perspective may suggest tractable solutions of how to address and eliminate these health disparities.
Quint, Elisabeth H
Adolescents with special needs have unique reproductive health care needs related to their physical and cognitive issues. This review discusses some of the most common concerns that are encountered in clinical practice, as the clinician will partner with the adolescent and her family to guide her through the pubertal transition and to help navigate the risks and rights of reproduction. Families often seek anticipatory guidance before menarche on menstrual hygiene, abuse risk and sexuality and can be reassured that most teens with special needs do very well with menstruation. The clinician needs to evaluate the teenager's reproductive knowledge as well her risk for abuse and coercion and her ability to consent to sexual activity, if she requests contraception. Menstrual management is mostly based on the impact of the menstrual cycles on the teenager's life and activities. The adolescents may have a decreased ability to tolerate menses or pain, or experience changes in seizure pattern or altered mood. Hormonal treatment is often used to assist with menstrual hygiene, cyclical mood changes or dysmenorrhea. The goal of treatment can be complete amenorrhea, alleviate pain or regulate and decrease menstrual flow. The unique risks and benefits of hormonal treatment for this special population are highlighted.
This article summarizes statements made by Dr. Nafis Sadik on October 19, 1998, to TICAD II. The address focused on the health challenges that Africa faces. The 1998 population in Africa of 780 million will double to about 1.5 billion in about 25 years. It is likely that this growth will impede socioeconomic development. Quality of life will be reduced by high infant and maternal mortality and high levels of HIV/AIDS. Only a small minority of Africans have access to basic health and reproductive health (RH) services. There are many unwanted births. The impact of HIV/AIDS on women has been very harsh. Life expectancy in some countries has been reduced. 50% of new HIV infections are among young people, who are poorly informed about RH. Health services are not suitable for youth needs. The consequences of early marriage and childbearing are limits to education and employment. Young women face the threat of domestic violence and abuse. Teenagers can be protected against HIV/AIDS and sexually transmitted diseases by institutionalization of sex education. RH needs to stress male responsibility in sexual health and childbearing. Sexual responsibility can be a life-and-death situation. African countries are beginning to integrate population and development policies. African countries need to adopt goals to increase access to RH services and family planning. Access should increase to 20% of population by the year 2000. Integrated programs, empowerment of women in development, male responsibility, and increased literacy should be expanded. UNFPA will continue to give Africa priority through increased resources, staff, and other partnerships.
Pariera, Katrina L; Hether, Heather J; Murphy, Sheila T; Buffington, Sandra de Castro; Baezconde-Garbanati, Lourdes
Prime-time broadcast television provides health information and establishes norms for millions of people in the United States (Beck, 2004; Brodie et al., 2001; Murphy & Cody, 2003; Rideout, 2008). To understand what people may be learning about reproductive and sexual health, a content analysis was conducted of story lines from the 10 most popular prime-time television programs in 2009, 2010, and 2011. Variables that were measured included the frequency of reproductive and sexual health issues, the level of health information, the type of information portrayed, the gain and loss frames, the presence of stigma, the tone, and the type of role model portrayed. Eighty-seven of the 589 health story lines dealt with reproductive and sexual health, and the most common issues were pre- and postterm pregnancy complications. The majority of these story lines had a moderate or weak level of information and included specifics about treatment and symptoms but not prevention. Just over half of the issues were framed in terms of losses, meaning nonadoption of a behavior change will result in negative outcomes. Twenty-four percent of reproductive and sexual health story lines involved stigma-usually stigma related to sexually transmitted infections (STIs). Most story lines were portrayed as serious and the majority of issues happened to positive role models. The implications of these portrayals for the viewing public are discussed.
Pillsbury, Barbara; Mayer, Doe
Women's nongovernmental organizations (NGOs) have significant comparative advantage for addressing sexual and reproductive health challenges facing women and families. This article describes an initiative to assist women's NGOs in developing greater skills using media and information communication technology for communicating women's health messages. Participating women's groups in Africa undertook innovative media projects--radio broadcasts on human immunodeficiency virus (HIV) and family planning, an antiviolence campaign, media campaigns on avoiding teen pregnancy--and designed websites, established Internet cafés, and downloaded health information from the Internet. Lessons learned offer guidance for collaboration with women's NGOs everywhere to strengthen communication for addressing critical sexual and reproductive health issues.
DeHart, Roy L
at least one physician on 85% of all its flights. Both passenger and cargo aircraft have proven to be vectors of disease in that they transport humans, mosquitoes, and other insects and animals who, in turn, transmit disease. Transmission to other passengers has occurred with tuberculosis and influenza. Vectors for yellow fever, malaria, and dengue have been identified on aircraft. Although there are numerous health issues associated with air travel they pale in comparison to the enormous benefits to the traveler, to commerce, to international affairs, and to the public's health.
Mbizvo, M T; Bassett, M T
Reproduction is a dual commitment, but so often in much of the world, it is seen as wholly the woman's responsibility. She bears the burden not only of pregnancy and childbirth but also the threats from excessive child bearing, some responsibility for contraception, infertility investigation and often undiagnosed sexually transmitted diseases (STDs) including AIDS. Failure to target men in reproductive health interventions has weakened the impact of reproductive health care programmes. The paper proposes that sophisticated and dynamic strategies in Africa and elsewhere which target women's reproductive health and research (such as control of STDs including AIDS, family planning, infertility investigation) require complementary linkage to the study and education of men. Men's perceptions, as well as determinants of sexual behavioural change and the socioeconomic context in which STDs, including AIDS, become rife, should be reviewed. There is a need to study and foster change to reduce or prevent poor reproductive health outcomes; to identify behaviours which could be adversely affecting women's reproductive health. Issues of gender, identity and tolerance as expressed through sexuality and procreation need to be amplified in the context of present risks in reproductive health. Researchers and providers often ignore the social significance of men. This paper reviews the impact of male dominance, as manifested through reproductive health and sexual decisions, against the background of present reproductive health problems. A research agenda should define factors at both macro and micro levels that interact to adversely impinge on reproductive health outcomes. This should be followed up by well-developed causal models of the determinants of positive reproductive health-promoting behaviours. Behaviour specific influences in sexual partnership include the degree of interpersonal support towards prevention, for example, of STDs, unwanted pregnancy or maternal deaths
Stevens, Leslie; Nolan, Martha; Greenberger, Phyllis
The term, women's health, was historically synonymous with reproductive health. When the prevailing thought among scientists and physicians was that women were just little men and reproductive organs were the only difference between the sexes, the Society for Women's Health Research (SWHR) was formed to change this conventional wisdom. SWHR realizes that austerity measures are necessary during hard economic times; however, we believe that sequestration is not the appropriate tool to reduce our federal deficit. Medical research, while vital to the scientific community, is also fundamental to the U.S. economy. Biomedical research and research on health statistics, surveillance data, and disease tracking are critical to maintaining a healthy society and are the difference between sickness and health for all women and their families.
Rich-Edwards, Janet W.; Gaskins, Audrey J.; Farland, Leslie V.; Terry, Kathryn L.; Zhang, Cuilin; Missmer, Stacey A.
Objectives. To review the Nurses’ Health Study’s (NHS’s) contribution to identifying risk factors and long-term health consequences of reproductive events. Methods. We performed a narrative review of the NHS I, NHS II, NHS3, and Growing Up Today Study (GUTS) publications between 1976 and 2016. Results. Collection of detailed reproductive history to identify breast cancer risk factors allowed the NHS to document an association between menstrual irregularities, a proxy for polycystic ovary syndrome (PCOS), and increased risk of diabetes and cardiovascular disease. The NHS II found that infertility associated with ovulation problems and gestational diabetes are largely preventable through diet and lifestyle modification. It also identified developmental and nutritional risk factors for pregnancy loss, endometriosis, and uterine leiomyomata. As women in NHS II age, it has become possible to address questions regarding long-term health consequences of pregnancy complications and benign gynecologic conditions on chronic disease risk. Furthermore, the NHS3 and GUTS are allowing new lines of research into human fertility, PCOS, and transgenerational effects of environmental exposures. Conclusions. The multigenerational resources of the NHSs and GUTS, including linkages of related individuals across cohorts, can improve women’s health from preconception through late adulthood and onto the next generation. PMID:27459445
Ranabhat, Chhabi; Kim, Chun-Bae; Choi, Eun Hee; Aryal, Anu; Park, Myung Bae; Doh, Young Ah
Different sociocultural barriers concerning women's health are still prevalent. Chhaupadi culture in Nepal is that threat wherein menstruating women have to live outside of the home in a shed-like dwelling. Our study aims to determine the factors of reproductive health problems related to Chhaupadi. A cross-sectional study was performed with women of menstrual age (N = 672) in Kailali and Bardiya districts of Nepal. Data were collected with stratified sampling and analyzed using SPSS. Reproductive health problems were observed according to the World Health Organization reproductive health protocol. Regression analysis was performed to show the association between relevant variables. Results reveal that one fifth (21%) of households used Chhaupadi. Condition of livelihood, water facility, and access during menstruation and precisely the Chhaupadi stay was associated (P < .001) with the reproductive health problems of women. The study concludes that Chhaupadi is a major threat for women's health. Further research on appropriate strategies against Chhaupadi and menstrual hygiene should be undertaken.
Quint, Elisabeth H
Most obstetrician-gynecologists will encounter adolescents with disabilities in their practice, because developmental and physical disabilities are common in young patients (8.4%). Reproductive health issues such as puberty, sexuality, and menstruation can be more complicated for teenagers with disabilities and their families as a result of concerns surrounding menstrual hygiene, abuse risk, vulnerability, changes in seizure pattern, and altered mood. Teenagers with disabilities have gynecologic health care needs similar to those of their peers as well as unique needs related to their physical and cognitive issues. The gynecologic health visit for a teenager with disabilities should include an evaluation of the teenager's reproductive knowledge as well as an assessment of her abuse and coercion risk and her ability to consent to sexual activity. The menstrual history is focused on the effects of menstrual cycles on her daily life. Diagnostic testing is not different from other adolescents. Hormonal treatment is often requested by the patient and her family to alleviate abnormal bleeding, cyclic mood changes, dysmenorrhea, or a combination of these, to assist with menstrual hygiene, and to provide contraception. Menstrual manipulation can be used to induce complete amenorrhea, regulate cycles, or decrease regular menstrual flow. However, treatment risks and side effects may have a different effect on the lives of these adolescents. The comfort level of health care providers to respond to the special concerns of adolescents with disabilities is low, and several barriers exist. This review addresses the complex issues of puberty, menstruation, sexuality, abuse, and safety highlighting the distinctive needs of this population. The options and decisions around menstrual manipulation are highlighted in detail.
Bosmans, Marleen; Nasser, Dina; Khammash, Umaiyeh; Claeys, Patricia; Temmerman, Marleen
This paper results from a study conducted in the Occupied Palestinian Territory in September 2002 to test the usefulness of a guide for a comprehensive approach to sexual and reproductive health rights and needs of refugee women. In-depth interviews with key informants from 19 organisations and two focus group discussions were carried out in the West Bank and Gaza. Three refugee camps were visited as well as five health facilities. The findings revealed that severe restrictions on mobility had reduced access to health facilities for both staff and patients in a significant way. For pregnant women, this had resulted in decreased access to antenatal and post-natal care and an increasing number of home deliveries, induced deliveries and deliveries at military checkpoints. Lack of donor interest and withdrawal of donor support were mentioned as hampering the implementation of the National Reproductive Health Guidelines, and the sustainability and quality of existing sexual and reproductive health services. Family planning had become a politically sensitive issue, and there were indications of increased gender-based violence. Lack of access to reproductive health services was the most visible aspect of the impact of the conflict on women's sexual and reproductive health. Little attention is paid to the less visible evidence that women's reproductive rights have been subordinated to the political situation.
The Palestinian Family Planning and Protection Association (PFPPA) recently implemented a new strategic plan based on the Strategic Plan of the International Planned Parenthood Federation (IPPF) aimed at the empowerment of women. Advocacy is the central part of the program with preparing the services and dealing with the issue of population. In early 1995 a round of meetings in the West Bank and the Gaza Strip launched the plan with new programs for women, youth, men, information, education, and communication, and service provision to start in January 1996. In Gaza the Youth Program is well under way. Five members were selected from each of 50 groups for a 1-week training course in Gaza City in November 1995. The topics included: mutual respect between husband and wife, discussion of the role of family planning in the context of Islam, the rights and wrongs of polygamy, and the hotly debated issue of sex segregation in education. The PFPPA staff was initially apprehensive about the new youth and women's program plans to broaden family planning to women's empowerment and sexual and reproductive health. An IPPF-sponsored video was also shown in Hebron, West Bank, on the problem of early marriage. It featured Palestinian women: one with 12 children who was married at age 13; a mother whose husband wanted to marry off their 12-year-old daughter; and portrayed pressure from husbands and other family members to produce many children. The new strategy engendered debate in the West Bank and Gaza among village women and young people, while in the meantime the training of government health workers started in sexual and reproductive health counseling. In the village of Tkooi, near Bethlehem, a counselor held sessions on the oppression of women and psycho-physiological problems and stress. A lawyer also summarized women's economic and property rights, which most of them were unaware of.
Kontic-Vucinic, Olivera; Sulovic, Nenad; Radunovic, Nebojsa
Proper nutritional status of women before, during, and after pregnancy is an important element of reproductive health. It maintains maternal health and reduces the risk of adverse pregnancy outcome, birth defects and chronic disease in children later in postnatal life. Pregnancy creates a special metabolic demand for high-quality nutrients. With careful food selection, it is possible to obtain most of the recommended levels of nutrients. Apart from the dietary intake, nutrition is highly dependant on economic status, social and cultural environment, and personal habits of the mother. Nutritional imbalance could cause detrimental effects to the pregnant woman, influence pregnancy outcome, and impair breast milk composition. Despite the extensive research, we still do not have a complete understanding how nutritional status of the mother influences her health as well as fetal growth and development. It is well known that fetal growth and development is strongly linked with maternal supply of essential nutrients, e.g. vitamins. The exact role of the variety of micronutrients in fetal growth and development has yet to be explored in detail. It is estimated that up to 30% of pregnant women suffer from a vitamin deficiency. Without supplementation, about 75% would show a deficit of at least one vitamin. Moreover, multivitamin deficit combinations often co-exist, and subclinical depletations are probably common; consequences could be severe. Studies carried on in developing countries have shown that improving micronutrient intake in deficient women can reduce maternal morbidity and mortality. Also, proper maternal intake of important micronutrients directly enhances the quality of breast milk. To meet the increasing demands during pregnancy and the breastfeeding period women should not be dependent only upon the dietary intake: adequate reserve is essential for the successful pregnancy outcome.
Garcia, Raul I.; Cadoret, Cindy; Henshaw, Michelle
Synopsis Demographic changes over the coming decades will heighten the challenges to the dental profession and to the nation. The expected growth in the numbers of racial and ethnic minorities, and the concomitant growth of immigrant populations are likely to lead to worsening of oral health disparities. Their consequences are becoming increasingly evident as the profession strives to improve the oral health of all Americans. The increasing diversity of the population, together with the importance of cultural beliefs and behaviors that affect health outcomes, will require ways to enhance provider-patient communications and oral health literacy. We discuss the nature and challenges presented by multicultural patient populations. One important means by which to promote oral health in diverse populations is to develop a dental workforce that is both culturally and linguistically competent, as well as one that is as culturally diverse as the American population. PMID:18329446
Spann, J.W.; Heinz, G.H.; Hulse, C.S.
Concentrations of 0, 1 and 3 ppm endrin in dry duck mash were fed to mallards (Anas platyrhynchos) starting in December, and health and reproduction were measured the following spring and summer. One male fed 3 ppm endrin died with 2.0 ppm endrin (wet weight), a diagnostically lethal level, in its brain. Birds fed 1 ppm endrin reproduced as well as, if not better than, controls. Birds fed 1 ppm endrin had significantly greater hatching success of fertile eggs than did those fed 0 or 3 ppm, and their clutches hatched significantly earlier than did those of birds fed 3 ppm. Mallards fed 3 ppm endrin appeared to reproduce more poorly than controls, but this finding must be regarded with caution because the results of statistical tests often were not significant. Endrin accumulated in eggs to a mean of 1.1 and 2.9 ppm (wet weight) when fed to hens at 1 and 3 ppm. The concentration of endrin in the cacasses of adults was similar to that in eggs, but the concentration in the fat of adults was about 4 to 7 times higher than in eggs.
McLachlan, John A; Simpson, Erica; Martin, Melvenia
There is growing evidence of the impact of estrogenic contaminants in the environment. Studies have shown that male fish in detergent-contaminated water express female characteristics, turtles are sex-reversed by polychlorinated biphenyls (PCBs), male frogs exposed to a common herbicide form multiple ovaries, pseudohermaphroditic offspring are produced by polar bears, and seals in contaminated water have an excess of uterine fibroids. Endocrine-disrupting chemicals (those found in the external environment that can mimic or inhibit endogenous hormones) mostly exhibit estrogenic effects, but a few are anti-estrogenic or anti-androgenic. Many of these compounds are industrial contaminants, such as pesticides and plasticizers, and others are natural phytoestrogens found in plants such as soy and in herbal supplements. Recent work shows that human development can also be feminized by exposure to estrogenic chemicals. Estrogen is the key hormone in the initiation (puberty) and the end (menopause) of reproductive life in women and thus of considerable importance in women's health. The same chemicals that affect wildlife may affect breast growth and lactation, and could have a role in uterine diseases such as fibroids and endometriosis. New studies provide a mechanism of action for estrogenic chemicals and other endocrine disrupters at the molecular level (called epigenetics) that may help explain the long-term effects of endocrine disruption.
The Human Rights Act (HR Act) 1998 (UK) (Human Rights Act, 1998) came into effect on October 2, 2000. Instead of taking a case to the European Court of Human Rights in Strasbourg, litigants can enforce their rights in the UK. The Act will have an unprecedented effect in virtually all areas of the UK legal systems. In line with those countries who have incorporated the 'Convention' in domestic law, litigation is expected to increase. The extensive body of Convention law, as well as decisions of the domestic courts of other states which have incorporated the Convention, now becomes an integral part of UK jurisprudence. Broadly, the Act applies to public and not private bodies. The relevant bodies which embody reproductive issues and concerns are for example the National Health Service (NHS) and the regulatory bodies such as the Human Fertilisation and Embryology Authority (HFEA) (Human Fertilisation and Embryology Authority Act, 1990) and the Human Genetics Advisory Commission (HGAC). A profound impact on the NHS practice, interpretations of the HFEA Act and its Code of Practice can be envisaged in relation to the Convention rights. Cases involving reproductive issues are already emerging in relation to the HR Act and which include sex selection, the present embryo transfer policy, interpretation of fatherless offspring and the provision of fertility services under the NHS. This review is intended to raise awareness of the HR Act 1998 for persons interested in human reproductive issues and how the HR Act could impact on the current laws and practice. Whilst it is only possible to speculate on what might happen in relation to the HR Act, what is certain is that UK law will radically change to accommodate the requirements of the HR Act 1998.
Edmunds, Lena; Rink, Elizabeth; Zukoski, Ann P.
The sexual health needs of young males have been largely ignored in the field of reproductive health. Until recently, the health care needs of females have received the vast majority of attention from public health professionals and organizations with services focused on the prevention of teen pregnancy, sexually transmitted infections, and…
Magnusson, Ulf; Persson, Sara
The objective of this review was to discuss whether endocrine disruption is a clinical concern in domestic animal reproduction. To that end, we firstly summarize the phenomenon of endocrine disruption, giving examples of the agents of concern and their effects on the mammalian reproductive system. Then there is a brief overview of the literature on endocrine disruptors and domestic animal reproduction. Finally, the clinical implications of endocrine disruptors on the reproductive system of farm animals as well as in dogs and cats are discussed. It is concluded that the evidence for clinical cases of endocrine disruption by chemical pollutants is weak, whereas for phytooestrogens, it is well established. However, there is concern that particular dogs and cats may be exposed to man-made endocrine disruptors.
Magnusson, Ulf; Persson, Sara
Contents The objective of this review was to discuss whether endocrine disruption is a clinical concern in domestic animal reproduction. To that end, we firstly summarize the phenomenon of endocrine disruption, giving examples of the agents of concern and their effects on the mammalian reproductive system. Then there is a brief overview of the literature on endocrine disruptors and domestic animal reproduction. Finally, the clinical implications of endocrine disruptors on the reproductive system of farm animals as well as in dogs and cats are discussed. It is concluded that the evidence for clinical cases of endocrine disruption by chemical pollutants is weak, whereas for phytooestrogens, it is well established. However, there is concern that particular dogs and cats may be exposed to man-made endocrine disruptors. PMID:26382024
Fernandez, Luz M; Becker, Jonathan A
The purpose of this article is to review women's health issues that affect underserved populations. Certain groups have a lack of health care resources or inability to access resources. Individuals encounter barriers to accessing health care due to socioeconomic status, transportation, intimate partner issues, and distrust of the health care system. These factors lead to health care disparities and a lack of appropriate care or quality care as it pertains to breast cancer screening, cervical cancer screening, and obtaining contraceptive care. Identifying available resources in response to community-based needs assessment is among the tools available to combat these inequalities.
Puri, S; Ketting, E
The International Planned Parenthood Federation has been advocating human rights since its establishment in 1952. Since the adoption of its global strategic plan, Vision 2000, it has dealt with advocacy in a more systematic manner. Advocacy aims to gain broader support for a cause. In family planning and reproductive health, advocacy is important in counteracting conservative opposition movements. Its most effective tool is high-quality information and services for meeting people's needs. Its target groups are women's groups, youth organizations, parliamentarians, media representatives, and religious leaders. Information, education, and communication (IEC) campaigns differ from advocacy, because the latter is deliberately persuasive and campaign-oriented. An Advocacy Working Group was convened by IPPF and an Advocacy Guide was produced in 1995. Advocacy is needed for the promotion of sexual and reproductive health in the face of opposition from traditional and cultural forces represented by small, vocal, well-financed and organized groups. In 1984 they succeeded in halting funding for IPPF by the United States. This made IPPF resolute in strategic planning and setting goals as contained in Vision 2000. The goals include advocacy for family planning, the prevention of unsafe abortion, women's empowerment, the involvement of youth, the responsibility of men for family life, and the improvement of the status of the female child. The IPPF's 1985 Central Council discussed new initiatives and an Issues Manual was published. The 1989 Members' Assembly held a seminar on critical issues in advocating family planning. A further 1993 resolution urged support for advocacy initiatives. A Public Response Guide was published in 1991 and Language Guidelines were also produced for correct family planning terminology. In addition, an Interregional Training Workshop was held in London in 1995 on the use of the Advocacy Guide. Recommendations were also submitted by participants for
Powell, Brent; Fletcher, J. Sue
There has been little research on undergraduate reproductive anatomy education. This pilot study explores knowledge of anatomical reproductive anatomy among university students in a lower division and upper division health course. Using a Qualtrics survey program, a convenience sample of 120 lower division and 157 upper division students for a…
Stiffman, Arlene Rubin, Ed.; Davis, Larry E., Ed.
The essays collected in this book examine the effects of ethnicity on the mental health of adolescents. A dual set of issues emerges throughout the volume: the importance of adolescent mental health in contributing to adult well-being, and the necessity of understanding ethnicity in studying and treating mental health problems. The book is divided…
California Univ., Berkeley. School of Public Health.
This document is a collection of 17 papers on theoretical issues in health education presented at the Dorothy Nyswander International Symposium. The introduction, entitled "Theory and Practice in Health Education: A Synthesis," attempts to highlight some of the features of these papers and their relevance for health education practice. The papers…
The possibility that solar activity and variations in the Earth's magnetic field may affect human health has been debated for many decades but is still a "scientific topic" in its infancy. By learning whether and, if so, how much the Earth's space weather can influence the daily health of people will be of practical importance. Knowing whether human genetics, include regulating factors that take into account fluctuations of the Earth's magnetic field and solar disturbances, indeed exist will also benefit future interplanetary space travelers. Because the atmospheres on other planets are different from ours, as well as their interaction with the space environment, one may ask whether we are equipped with the genetics necessary to take this variability into account. The goal of this presentation is to define what is meant by space weather as a health risk and identify the long-term socio-economic effects on society that such health risks would have. Identifying the physical links between space weather sources and different effects on human health, as well as the parameters (direct and indirect) to be monitored, the potential for such a cross-disciplinary study will be invaluable, for scientists and medical doctors, as well as for engineers.
Jennings, Richard T.
Women have been an integral part of US space crews since Sally Ride's mission in 1983, and a total of 40 women have been selected as US astronauts. The first Russian female cosmonaut flew in 1963. This presentation examines the health care and reproductive aspects of flying women in space. In addition, the reproductive implications of delaying one's childbearing for an astronaut career and the impact of new technology such as assisted reproductive techniques are examined. The reproductive outcomes of the US female astronauts who have become pregnant following space flight exposure are also presented. Since women have gained considerable operational experience on the Shuttle, Mir and during EVA, the unique operational considerations for preflight certification, menstruation control and hygiene, contraception, and urination are discussed. Medical and surgical implications for women on long-duration missions to remote locations are still evolving, and enabling technologies for health care delivery are being developed. There has been considerable progress in the development of microgravity surgical techniques, including laparoscopy, thoracoscopy, and laparotomy. The concepts of prevention of illness, conversion of surgical conditions to medically treatable conditions and surgical intervention for women on long duration space flights are considered.
Galdos Silva, Susana
The article focuses on the International Conference on Population and Development held in El Cairo, Egypt, in 1994. The Conference addressed issues related to sexual and reproductive rights, actions to be adopted to improve the situation of young girls, the status of women, the situation of adolescents and gender equality as basic components to improve the sexual and reproductive health of the population. The concluding recommendations in this conference constitute the action program. This document also addresses some issues that generated long discussions to reach consensus during the conference. It summarizes the follow up performed on the action program in the following years and ends with the report of the Peruvian government and the civil society twenty years after the conference.
Toxics use reduction is a new chemical hazard management approach that has emerged in several state laws over the past years. While toxics use reduction has been promoted as a means of preventing environmental pollution, little thought has been given to its adoption as a means of managing reproductive hazards. This paper provides illustrations of use reduction approaches to conventionally recognized reproductive and developmental toxicants. These approaches will require the opening of a new dialogue between industrial designers and process managers and those most concerned about reproductive health. Several different strategies are proposed that might be adopted into state programs for promoting reduction in the use of reproductive and developmental toxicants. PMID:8243394
Newman, Karen; Fisher, Sarah; Mayhew, Susannah; Stephenson, Judith
This article suggests that sexual and reproductive health and rights activists seeking to influence the post-2015 international development paradigm must work with sustainable development advocates concerned with a range of issues, including climate change, environmental issues, and food and water security, and that a way of building bridges with these communities is to demonstrate how sexual and reproductive health and rights are relevant for these issues. An understanding of population dynamics, including urbanization and migration, as well as population growth, can help to clarify these links. This article therefore suggests that whether or not sexual and reproductive health and rights activists can overcome resistance to discussing "population", become more knowledgeable about other sustainable development issues, and work with others in those fields to advance the global sustainable development agenda are crucial questions for the coming months. The article also contends that it is possible to care about population dynamics (including ageing and problems faced by countries with a high proportion of young people) and care about human rights at the same time. It expresses concern that, if sexual and reproductive health and rights advocates do not participate in the population dynamics discourse, the field will be left free for those for whom respecting and protecting rights may be less of a priority.
Nguyen, My Hu'o'ng; Gammeltoft, Tine; Christoffersen, Sarah Vigh; Tran, Thu Thuy; Rasch, Vibeke
Research was conducted on reproductive tract infections among women obtaining induced abortions at Ph[image omitted]-[image omitted] hospital in Haiphong City, a major maternity hospital in northern Vietnam. The research aimed to explore how clinicians and lab-technicians diagnose reproductive tract infections and the difficulties they experience in establishing exact diagnoses. A combination of both quantitative and qualitative research methodologies was employed. The quantitative research involved 748 abortion-seeking women; the qualitative research was conducted with 10 doctors and 10 lab-technicians providing reproductive health services. A marked tendency was observed among both clinicians and lab-technicians to overdiagnose reproductive tract infections and to prescribe antibiotics routinely. Social, cultural, and clinical factors associated with the tendency to overdiagnose reproductive tract infections included: inadequate training of health staff, lack of equipment, and cultural assumptions regarding the overwhelming prevalence of reproductive tract infections in Vietnamese women, especially among those who receive abortion services. Misconceptions of reproductive tract infections led to substantial over-diagnosis and unnecessary treatment of reproductive tract infections in this hospital. To enhance reproductive tract infection care, providers need to be sensitized to the social and medical consequences of their own cultural perceptions and to increase their awareness of the risks associated with overuse of antibiotics.
Reid, Inez Smith
Black women in the United States experience a high incidence of serious health problems and, as a group, receive insufficient and inadequate medical care. The death rate for black women suffering from breast cancer has increased substantially since 1950. Also of great concern is the high incidence of cervical cancer in low income black women…
Mody, Girish M; Brooks, Peter M
Musculoskeletal (MSK) disorders are among the leading reasons why patients consult a family or primary health practitioner, take time off work and become disabled. Many of the MSK disorders are more common in the elderly. Thus, as the proportion of the elderly increases all over the world, MSK disorders will make a greater contribution to the global burden of disease. Epidemiological studies have shown that the spectrum of MSK disorders in developing countries is similar to that seen in industrialised countries, but the burden of disease tends to be higher due to a delay in diagnosis or lack of access to adequate health-care facilities for effective treatment. Musculoskeletal pain is very common in the community while fibromyalgia is being recognised as part of a continuum of chronic widespread pain rather than a narrowly defined entity. This will allow research to improve our understanding of pain in a variety of diffuse pain syndromes. The availability of newer more effective therapies has resulted in efforts to initiate therapy at an earlier stage of diseases. The new criteria for rheumatoid arthritis, and the diagnosis of axial and peripheral involvement in spondyloarthritis, permit an earlier diagnosis without having to wait for radiological changes. One of the major health challenges is the global shortage of health workers, and based on current training of health workers and traditional models of care for service delivery, the global situation is unlikely to change in the near future. Thus, new models of care and strategies to train community health-care workers and primary health-care practitioners to detect and initiate the management of patients with MSK disorders at an earlier stage are required. There is also a need for prevention strategies with campaigns to educate and raise awareness among the entire population. Lifestyle interventions such as maintaining an ideal body weight to prevent obesity, regular exercises, avoidance of smoking and alcohol
Federally qualified health centers face numerous issues with regard to marketplace competition, staffing, and reimbursement streams that assure financial viability. Positioning the dental department of a health center to a high community profile strengthens the health center in professional educational development leading to a pipeline of workforce members, effective dental directors, and innovative fund-raising. A new dental team member developed by the American Dental Association can be utilized in health centers to make all traditional auxiliaries more productive.
... Procedures Home, Business, and Entertainment Products Cell Phones Health Issues Share Tweet Linkedin Pin it More sharing ... it Email Print Do cell phones pose a health hazard? Many people are concerned that cell phone ...
Trieu, Sang Leng; Bratton, Sally; Marshak, Helen Hopp
Objective: To explore the sexual and reproductive health behaviors of students from 13 community college campuses in California. Participants: Heterosexual college students, ages 18 to 24, who have had sexual intercourse (N = 4,487). Methods: The American College Health Association's National College Health Assessment (ACHA-NCHA) survey was…
LIVELY, C. M.; MORRAN, L. T.
Sexual reproduction is widely regarded as one of the major unexplained phenomena in biology. Nonetheless, while a general answer may remain elusive, considerable progress has been made in the last few decades. Here we fist review the genesis of, and support for, the major ecological hypotheses for biparental sexual reproduction. We then focus on the idea that host-parasite coevolution can favor cross fertilization over uniparental forms of reproduction, as this hypothesis currently has the most support from natural populations. We also review the results from experimental evolution studies, which tend to show that exposure to novel environments can select for higher levels of sexual reproduction, but that sex decreases in frequency after populations become adapted to the previously novel conditions. In contrast, experimental coevolution studies suggest that host-parasite interactions can lead to the long-term persistence of sex. Taken together, the evidence from natural populations and from laboratory experiments point to antagonistic coevolution as a potent and possibly ubiquitous force of selection favoring cross-fertilization and recombination. PMID:24617324
Business and Professional Women's Foundation, Washington, DC.
Reproductive rights are essential to a woman's full participation in the workplace. Procreative decisions are private ones, and once the door is open to government restrictions it will be hard to close. Prior to 1850, abortion was legal in most states. Not until the professionalization of the medical field did physicians and others seek to…
Instone, Susan; Mueller, Mary-Rose
The number of HIV-positive Latinas of child-bearing age living on the US-Mexico border is a growing concern. Little is known about how religious beliefs influence the reproductive health decisions of these women in light of disease demands and cultural and religious norms that support high fertility rates and childbearing. Such decisions may be further complicated by the stigma of HIV/AIDS and structural issues related to immigration status and trans-border lives. This paper analyzes extant literature and supports the need for further research so that policy makers and heath and social service providers can develop meaningful and comprehensive reproductive-health related interventions.
As interest in women's health issues grows, there is increasing concern that today's practice of medicine may not meet the health needs of women. A primary reason is the gender bias that has been inherent in medical education, research and clinical practice. The prevailing medical viewpoint has often been that the male body is considered to be the norm and that the female body exactly the same except for the reproductive function. This attitude has led to a lack of interest in researching gender differences and a consequent lack of knowledge of women's health issues. Fortunately, there is a movement for change. The Women's Health Interschool Curriculum Committee was formed in January 1992 to develop curricula concerning women's health and examine bias that may exist in existing curricula. The Canadian Women's Health Network has been growing across the country and there have been calls to create a new specialty in women's health. According to Angell, this proposal for a new specialty was provocatively debated in the Journal of Women's Health, which started publication in 1992. There is also a growing concern on how to conduct better research to address women's health needs. As more attention is paid to women's health issues, what will happen in the area of oral health? In health care, it would seem that the mouth has become completely separated from the rest of the body. Health conferences rarely have any oral health content at all. To correct this problem, there must be an increase in general awareness of the importance of oral health as it relates to the overall health of both women and men. Good oral health is more than just decay-free teeth. Oral health encompasses the teeth, the supporting periodontal structures, soft tissues of the mouth and oral pharynx area, temporomandibular joints and muscles of mastication. The mouth is a gateway to the body and will also reflect many systemic health problems, such as diabetes, leukemia and lupus. The second step would be
Jeng, Hueiwang Anna
Endocrine disrupting chemicals (EDCs) can interfere with normal hormonal balance and may exert adverse consequences on humans. The male reproductive system may be susceptible to the effects of such environmental toxicants. This review discusses the recent progress in scientific data mainly from epidemiology studies on the associations between EDCs and male reproductive health and our understanding of possible mechanisms associated with the effects of EDCs on male reproductive health. Finally, the review provides recommendations on future research to enhance our understanding of EDCs and male reproductive health. The review highlights the need for (1) well-defined longitudinal epidemiology studies, with appropriately designed exposure assessment to determine potential causal relationships; (2) chemical and biochemical approaches aimed at a better understanding of the mechanism of action of xenoestrogens with regard to low-dose effects, and assessment of identify genetic susceptibility factors associated with the risk of adverse effects following exposure to EDCs. PMID:24926476
Nimmo, Margaret L.
This Kids Count report examines issues related to children's mental health in Virginia. The report discusses the effects of children's mental illness, presents risk and protective factors, and describes the incidence of children's mental health problems. Information specific to Virginia is presented, including the prevalence of youth suicide,…
Many adolescents need basic health care and other services that address risky behaviors such as sexual activity, violence, alcohol and drug abuse, and the consequences of these behaviors. This publication summarizes laws and resolutions on adolescent health issues passed in 1997 state and territory legislative sessions. No 1997 legislative session…
Richardson, Glenn E.; Jose, Nancy
The need for a code of ethics for health educators is discussed, and results of a survey of school health educators' opinions on curriculum-related ethical issses are reported. Ethical issues of concern include use of scare tactics, efforts to change behavior and attitudes, and appropriate subject matter. (PP)
Savage, Melissa Hough; Ourada, Joanne
Many adolescents need basic health care and other services that address risky behaviors such as sexual activity, violence, alcohol and other drug abuse, and the consequences of those behaviors. This publication summarizes approximately 250 laws and resolutions concerning adolescent health and related issues passed by the 50 states and the District…
Cook, R J
This paper analyzes the Programme of Action of the 1994 International Conference on Population and Development (ICPD) and the Platform for Action of the 1995 Fourth World Conference on Women (FWCW) to explicate the principles contained in these documents that might be used to develop a national reproductive health law. The introductory section of the paper describes how the use of human rights principles to advance reproductive health and empower women has grown and reprints the ICPD definition of reproductive health as well as the portion of the FWCW Platform that links women's human rights and reproductive health. The next section shows how the following human rights can be applied to an effort to protect reproductive interests: 1) the right to life and survival (protection from pregnancy-related death); 2) the right to liberty and security of the person (protection from restrictive or coercive abortion policies, from restricted or coercive contraception and sexual sterilization, and from female genital mutilation as well as protection of the right to a private life); 3) the right to the highest attainable standard of health (violated by the unmet need for family planning); 4) the right to the benefits of scientific progress; 5) the right to receive and impart information; and 6) the right to nondiscrimination on the basis of sex, age, or disability. The final section of the paper discusses how an alliance of health and legal professionals could lobby governments to enact reproductive health laws that enforce human rights and are accompanied by a reproductive rights impact assessment of relevant policies, ethical codes for health practitioners, and compliance mechanisms.
Sanneving, Linda; Trygg, Nadja; Saxena, Deepak; Mavalankar, Dileep; Thomsen, Sarah
Background Millennium Development Goal (MDG) 5 is focused on reducing maternal mortality and achieving universal access to reproductive health care. India has made extensive efforts to achieve MDG 5 and in some regions much progress has been achieved. Progress has been uneven and inequitable however, and many women still lack access to maternal and reproductive health care. Objective In this review, a framework developed by the Commission on Social Determinants of Health (CSDH) is used to categorize and explain determinants of inequity in maternal and reproductive health in India. Design A review of peer-reviewed, published literature was conducted using the electronic databases PubMed and Popline. The search was performed using a carefully developed list of search terms designed to capture published papers from India on: 1) maternal and reproductive health, and 2) equity, including disadvantaged populations. A matrix was developed to sort the relevant information, which was extracted and categorized based on the CSDH framework. In this way, the main sources of inequity in maternal and reproductive health in India and their inter-relationships were determined. Results Five main structural determinants emerged from the analysis as important in understanding equity in India: economic status, gender, education, social status (registered caste or tribe), and age (adolescents). These five determinants were found to be closely interrelated, a feature which was reflected in the literature. Conclusion In India, economic status, gender, and social status are all closely interrelated when influencing use of and access to maternal and reproductive health care. Appropriate attention should be given to how these social determinants interplay in generating and sustaining inequity when designing policies and programs to reach equitable progress toward improved maternal and reproductive health. PMID:23561028
Ngo, Anh D; Hill, Peter S
This paper presents a qualitative study conducted in 2009 of provider and patient perceptions of primary level reproductive health services provided by commune health stations (CHSs), and the implications for Viet Nam's 2011-2020 National Strategy for Reproductive Health Care. In the three provinces of Thai Nguyen, Thua Thien Hue, and Vinh Long, we interviewed the heads of CHSs, held focus group discussions with midwives and women patients, and observed facilities. Half the 30 CHSs visited were in poor physical condition; the rest were newly renovated. However, the model of service delivery was largely unchanged from ten years before. Many appeared to fall short in meeting patient expectations in terms of modern medical equipment and technology, range of drug supplies, and levels of staff expertise. As a result, many women were turning to private doctors and public hospitals, at least in urban areas, or seeking medication from pharmacies. To make CHS clinics sustainable, promotion of access to reproductive health services should be undertaken concurrently with quality improvement. A responsive payment scheme must also be developed to generate revenues. Efforts should be made to reduce the unnecessary use of more costly services from private clinics and higher level public facilities.
Behrman, Julia Andrea; Weitzman, Abigail
This article explores the effects of the 2010 Haiti earthquake on women's reproductive health, using geocoded data from the 2005 and 2012 Haiti Demographic and Health Surveys. We use geographic variation in the destructiveness of the earthquake to conduct a difference-in-difference analysis. Results indicate that heightened earthquake intensity reduced use of injectables-the most widely used modern contraceptive method in Haiti-and increased current pregnancy and current unwanted pregnancy. Analysis of impact pathways suggests that severe earthquake intensity significantly increased women's unmet need for family planning and reduced their access to condoms. The earthquake also affected other factors that influence reproductive health, including women's ability to negotiate condom use in their partnerships. Our findings highlight how disruptions to health care services following a natural disaster can have negative consequences for women's reproductive health.
Forensic mental health traditionally was considered the backwater of forensic practice. However, because of advances in knowledge regarding the core issues of capacity and risk, and because of changes in the location of forensic assessment and treatment, "forensic" issues now permeate mental health practice and policy. While these advances have been important, there are a number of new issues that will occupy the attention of practitioners, researchers, and policymakers in the future. This article explores these issues and their implications, including the need to better integrate treatment and risk; the need to address the emergence of special jurisdiction courts and their impact on systems design issues; the need to address the impact of conservative social policies, particularly in the areas of juvenile justice and sexual predator legislation; and the need to better understand the use of coercion in the context of community treatment.
Angier, J J
Consumer health information as applied to mental health includes areas such as the diagnosis, management, and treatment of mental illness, as well as self-help, emotional wellness, and the relationship between life events, stress, and disease. This paper presents issues specific to the provision of mental health information to the layperson, e.g., confidentiality, literacy, competence, the social stigma of mental illness, the state of the art in psychiatry, popular psychology, and treatment fads. The development of a community education pamphlet illustrates how one organization addressed these issues.
Adams, Lisa; Suresh, Gautham K; Lahey, Tim
Children are vulnerable to the priorities and decision-making of adults. Usually, parents/caregivers make the difficult healthcare decisions for their children based on the recommendations from the child's healthcare providers. In global health work, healthcare team members from different countries and cultures may guide healthcare decisions by parents and children, and as a result ethical assumptions may not be shared. As a result, ethical issues in pediatric global health are numerous and complex. Here we discuss critical ethical issues in global health at an individual and organizational level in hopes this supports optimized decision-making on behalf of children worldwide.
Loutfy, Mona R; Sonnenberg-Schwan, Ulrike; Margolese, Shari; Sherr, Lorraine
The study of pregnancy and motherhood in women living with HIV (WLWH) has concentrated on the health of the unborn baby and the prevention of mother-to-child transmission, whereas consideration of the broader aspects of women's reproductive health has been largely overlooked. The rights of WLWH with respect to their reproductive health should be exactly the same as non-HIV-positive women, however, inequalities exist due to discrimination and also because the treatment guidelines used in the care of women are often based on insufficient evidence. The purpose of this article is to review the available literature on reproductive health issues for WLWH and to identify gaps requiring further investigation. Our review indicates that further research is warranted into a number of aspects of reproductive health among WLWH. Currently, access to the relevant reproductive health resources and services, such as advice on contraception and fertility services, for WLWH is far from optimal in many developed countries and most developing countries. More data are needed on the most appropriate family planning options with the consideration of drug interactions between contraceptives and antiretroviral therapy and the risk of HIV transmission. Also, more research is needed to improve understanding of the maternal health challenges facing WLWH. Similarly, our understanding of the impact of HIV on the physical and emotional health of pregnant women and new mothers is far from complete. Answering these questions and countering these inequalities will help to ensure the reproductive health and child-bearing intentions of WLWH become an integral part of HIV medicine.
Health care for mothers and children has been a cornerstone of the Swedish system of health care for many years, starting in the 1930s, when a national network of maternal health centers offered a variety of free prenatal services. This paper describes modern maternal health services whose primary goal is preventive care. Instruments for attaining this goal are regular check-ups for early detection of problems and for maintenance of good health; social and psychological support to expectant parents; information and training to prepare parents for delivery and parenting; information and education about risk factors in the parents' local environment and in society in general. Details of how these programs were developed, delivered and evaluated are provided by the author, a former Senior Medical Officer at the National Board of Health and Welfare, responsible for maternal health care and family planning on a national level.
Schleissing, S.; Kersten, J.; Thaler, C. J.; von Schönfeldt, V.
Reproductive medicine laws in Germany currently mean that the relationship status of prospective parents is taken into consideration in decisions on whether their application for assisted reproduction is approved or rejected. In the light of new forms of shared parenthood, we should ask ourselves whether the current regulations are still an appropriate way of guaranteeing the best for the child. Current medical practices and their legal basis will be illustrated using the examples of sperm, egg and embryo donation. From an ethical perspective, the question at stake is to what extent an “Ethics of Parenthood” can make it possible to act responsibly with regard to the changes occurring in forms of shared parenthood. Such an ethics is aimed at supporting parents in realising the reproductive autonomy guaranteed in the German Constitution through social and ethical aspects of the child–parent relationship. PMID:25089055
Lincoln, D W
World population will increase by 1000 million, or by 20%, within 10 years. Ninety-five per cent of this increase will occur in the South, in areas that are already economically, environmentally and politically fragile. Morbidity and mortality associated with reproduction will be greater in the current decade than in any period in human history. Annually, 40-60 million pregnancies will be terminated and 5-10 million children will die within one year of birth. AIDS-related infections, e.g. tuberculosis, will undermine health care in Africa (and elsewhere) and in places AIDS-related deaths will decimate the work-force. The growth in population and associated morbidity will inhibit global economic development and spawn new problems. The key issues are migration, the spread of disease, the supply of water and the degradation of land, and fiscal policies with respect to family planning, pharmaceuticals and Third-World debt. Full education, particularly of women, and more effective family planning in the South have the power to unlock the problem. Failure will see the developed countries, with their 800 million population, swamped by the health, economic and environmental problems of the South, with its projected population of 5400 million people for the year 2000.
Gaydos, Laura M; Smith, Alexandria; Hogue, Carol J R; Blevins, John
Separate from scholarship in religion and medicine, a burgeoning field in religion and population health, includes religion and reproductive health. In a survey of existing literature, we analyzed data by religious affiliation, discipline, geography and date. We found 377 peer-reviewed articles; most were categorized as family planning (129), sexual behavior (81), domestic violence (39), pregnancy (46), HIV/AIDS (71), and STDs (61). Most research occurred in North America (188 articles), Africa (52), and Europe (47). Article frequency increased over time, from 3 articles in 1980 to 38 articles in 2008. While field growth is evident, there is still no cohesive "scholarship" in religion and reproductive health.
Rojas-Guyler, Liliana; Price, Kimberly L. J.; Young, Kathleen; King, Keith A.
Objectives: The purpose of this study was to assess potential relationships among reproductive health knowledge, preventive health behaviors, perceived severity and risk of breast cancer, cervical cancer, and sexually transmitted infections and selected demographical variables and characteristics related to acculturation among Latina immigrants.…
Elfers, John; Carlton, Lidia; Gibson, Paul; Puffer, Maryjane; Smith, Sharla; Todd, Kay
The Adolescent Sexual Health Work Group commissioned the development of core competencies that define the knowledge, skills, and attitudes necessary for all providers of adolescent sexual and reproductive health. This article describes the background and rationale for this set of competencies, the history and use of competencies, and the process…
Chi, Primus Che; Urdal, Henrik; Umeora, Odidika Uj; Sundby, Johanne; Spiegel, Paul; Devane, Declan
This is the protocol for a review and there is no abstract. The objectives are as follows: To identify, synthesise and evaluate the effects of health system and other interventions aimed at improving maternal, newborn and women's reproductive health in crisis settings.
Bassoff, Betty Z.; Ortiz, Elizabeth T.
Although the military health care system is the second largest in the nation serving approximately 6,000,000 people, little research has examined military reproductive health care services or their quality. Medical services can be provided by regional military medical centers and by base infirmaries and dispensaries. Often base infirmaries and…
Scheftel, Joni M; Elchos, Brigid L; Rubin, Carol S; Decker, John A
OBJECTIVE To review publications that address female reproductive health hazards in veterinary practice, summarize best practices to mitigate reproductive risks, and identify current knowledge gaps. DESIGN Systematized review. SAMPLE English-language articles describing chemical, biological, and physical hazards present in the veterinary workplace and associations with adverse reproductive outcomes or recommendations for minimizing risks to female reproductive health. PROCEDURES Searches of the CAB abstracts database were performed in July 2012 and in May 2015 with the following search terms: veterinarians AND occupational hazards and vets.id AND occupational hazards.sh. Searches of the PubMed database were conducted in November 2012 and in May 2015 with the following medical subject heading terms: occupational exposure AND veterinarians; anesthetics, inhalation/adverse effects AND veterinarians; risk factors AND pregnancy AND veterinarians; pregnancy outcome AND veterinarians; and animal technicians AND occupational exposure. Two additional PubMed searches were completed in January 2016 with the terms disinfectants/toxicity AND female AND fertility/drug effects and veterinarians/psychology AND stress, psychological. No date limits were applied to searches. RESULTS 4 sources supporting demographic trends in veterinary medicine and 118 resources reporting potential hazards to female reproductive health were identified. Reported hazards included exposure to anesthetic gases, radiation, antineoplastic drugs, and reproductive hormones; physically demanding work; prolonged standing; and zoonoses. CONCLUSIONS AND CLINICAL RELEVANCE Demographic information suggested that an increasing number of women of reproductive age will be exposed to chemical, biological, and physical hazards in veterinary practice. Information on reproductive health hazards and minimizing risk, with emphasis on developing a safety-focused work culture for all personnel, should be discussed starting
Amoo, Emmanuel O; Oni, Gholahan A; Ajayi, Mofoluwake P; Idowu, Adenike E; Fadayomi, Theophilus O; Omideyi, Adekunbi K
The study examined men's reproductive health problems and sexual behavior and their implications for men's welfare in Nigeria. It used the Nigeria Demographic and Health Survey data set of 2013. The analysis used only male recode files, representing 17,359 males. The dependent variable is the computed wealth index, which was selected as proxy for welfare condition. Analysis involved univariate and multivariate levels. The findings indicated that 49.3% of the respondents currently have more than one sexual partner. The total lifetime sexual partner index identifies 70.2% of the men interviewed have had at least two sexual partners in their lifetime. It revealed that men who experience reproductive health challenges, such as sexually transmitted infections and genital ulcer, are 44% and 93%, respectively, less likely to enjoy good welfare condition. It also indicated that men in urban area are 7.256 times more likely to enjoy good welfare condition compared with their rural counterparts. There is a negative association between total lifetime sexual partnerships and exposure to good welfare. The study concludes that social workers, marriage counselors, other health personnel, and policy makers need to focus on the practice of multiple sexual partnership and reproductive health diseases as major determinants of men's welfare. The authors suggest that the index of welfare should include reproductive health issues and indicators of sexual behavior. Also, there is need for the establishment of specialized reproductive health care services and centers that are accessible to all men for effective servicing of reproductive health needs of men in the country.
Alcser, K.H.; Brix, K.A.; Fine, L.J.; Kallenbach, L.R.; Wolfe, R.A.
This retrospective cohort study was designed to investigate the relationship of male occupational exposure to elemental mercury and several reproductive outcomes. All subjects worked at least 4 months between 1953 and 1966 at a plant that used elemental mercury; 247 white male employees who had the highest exposures were compared to 255 matched nonexposed employees. Individual exposure to mercury was estimated from urinary mercury measurement records. Information on reproductive history and potential confounding variables was obtained through personal interview with each of the employees and with a subset of their wives. No associations were demonstrated between mercury exposure and decreased fertility or increased rates of major malformations or serious childhood illnesses. After controlling for previous miscarriage history, mercury exposure was not a significant risk factor for miscarriage. Because of this study's potential problems with long-term recall, further studies of the effect of mercury on pregnancy outcome are warranted in other populations.
This document reports on and summarizes a paper written by Dr. Aurora Perez. The paper, entitled "The Ambiguities and Ambivalence on Abortion Issues in the Philippines," has tackled abortion from a different perspective, treating it as an issue of public health and human rights. It is a public health issue because the prevalence of abortion is a negative reflection of women's access to effective contraception. It is a human rights issue in the context of sexual violence, and Perez has urged a policy that allows therapeutic abortion as a human right of raped women. She also emphasized that maternal death was high in the Philippines because Filipino women were seeking abortion services under unsafe conditions. Perez cited a study, conducted in 1985-86, which showed that 24% of maternal deaths were due to induced abortions.
Ferguson, T S; Tulloch-Reid, M K; Gordon-Strachan, G; Hamilton, P; Wilks, R J
Over the last six decades, comprehensive national health surveys have become important data-gathering mechanisms to inform countries on their health status and provide information for health policy and programme planning. Developing countries have only recently begun such surveys and Jamaica has been at the forefront of this effort. Jamaica's Reproductive Health Surveys and programme response to their findings have resulted in an almost 50% reduction infertility rates over three decades as well as a 40% reduction in unmet contraceptive needs and a 40% reduction in unplanned pregnancies over the last two decades. The Jamaica Health and Lifestyle Surveys have served to reinforce the major burden that non-communicable diseases place on the society and the extent to which these are driven by unhealthy lifestyles. These surveys have shown that obesity, hypertension, diabetes and dyslipidaemia affect approximately 50%, 25%, 10% and 10% of the adult population, respectively. These surveys have documented low rates of treatment and control for these chronic non-communicable diseases despite two major policy initiatives, the National Programme for the Promotion of Healthy Lifestyles and the creation of the National Health Fund which subsidizes healthcare provision for chronic diseases. In order to maximize the uptake of the findings of future surveys into effective health policy, there will need to be effective collaborations between academia, policy-makers, regional and international health agencies, non-government organizations and civil society. Such collaborations should take into account the social, political and economic issues, thus ensuring a more comprehensive approach to health policy and result in improvement of the nation's health status and by extension national development.
Zephyrin, Laurie C
There are more than 2 million women veterans living in the United States. Many women do not identify themselves as veterans. As women's health care providers, it is important to understand and recognize the potentially complex health and social needs of women veterans and the role of military service on their lives. The reproductive health needs of women veterans may be shaped by their military experiences and coexisting medical or mental health conditions. Military sexual trauma and combat exposure are common causes of posttraumatic stress disorder and can affect overall health and well-being. Screening for military service is important in all women, and inclusion of this as a key demographic variable in research and clinical encounters can further inform health care considerations. The following key topics are addressed: who are women veterans, health and social risk factors associated with a history of military service, reproductive health across the life course, military sexual trauma and reproductive health of women veterans, how to take a military history, and the essential role of women's health providers, including obstetrician-gynecologists, in enhancing health systems and providing high-quality care to veterans.
Ravindran, T K Sundari
Privatisation in Pakistan's health sector was part of the Structural Adjustment Programme that started in 1998 following the country's acute foreign exchange crisis. This paper examines three examples of privatisation which have taken place in service delivery, management and capacity-building functions in the health sector: 1) large-scale contracting out of publicly-funded health services to private, not-for-profit organisations; 2) social marketing/franchising networks providing reproductive health services; and 3) a public-private partnership involving a consortium of private players and the government of Pakistan. It assesses the extent to which these initiatives have contributed to promoting equitable access to good quality, comprehensive reproductive health services. The paper concludes that these forms of privatisation in Pakistan's health sector have at best made available a limited range of fragmented reproductive health services, often of sub-optimal quality, to a fraction of the population, with poor returns in terms of health and survival, especially for women. This analysis has exposed a deep-rooted malaise within the health system as an important contributor to this situation. Sustained investment in health system strengthening is called for, where resources from both public and private sectors are channelled towards achieving health equity, under the stewardship of the state and with active participation by and accountability to members of civil society.
Beh, Hazel G; Pietsch, James H
This article focuses on the thorny and evolving legal issues and implications of health care decision-making for children and adolescents in matters of gender, sexual identity, sexual conduct, and reproduction. In treating minors, health care professionals increasingly experience competing duties and responsibilities to their patient, the parents or guardians, and to the state. This article gives health care professionals a foundation for understanding the legal concepts of adolescent health care decision-making and provides an approach for balancing the potential competing interests of these stakeholders while complying with professional standards,the law, and their own ethical and moral convictions.
Zakrajsek, James J.; Dempsey, Paula J.; Huff, Edward M.; Augustin, Michael; Safa-Bakhsh, Robab; Ephraim, Piet; Grabil, Paul; Decker, Harry J.
This paper presents an overview of health management issues and challenges that are specific to rotorcraft. Rotorcraft form a unique subset of air vehicles in that their propulsion system is used not only for propulsion, but also serves as the primary source of lift and maneuvering of the vehicle. No other air vehicle relies on the propulsion system to provide these functions through a transmission system with single critical load paths without duplication or redundancy. As such, health management of the power train is a critical and unique part of any rotorcraft health management system. This paper focuses specifically on the issues and challenges related to the dynamic mechanical components in the main power train. This includes the transmission and main rotor mechanisms. This paper will review standard practices used for rotorcraft health management, lessons learned from fielded trials, and future challenges.
The Internet has turned during the past decade into a major information resource in various domains of life and a communication venue among adolescents who seek health information via the net. The increasing availability of computers in homes, as well as wireless Internet access, means that adolescents today can go online anywhere, at any time. The media are not the leading cause of any major health problem, but they do contribute significantly to a variety of adolescent health problems, including aggressive behavior, sexual activity, drug use, obesity, sleep disorders, eating disorders, depression, suicide and self harm. This paper focuses on 3 major health issues in adolescents' Internet use: Body image and eating behaviors; sexuality and reproductive health behaviors; and self harm and suicidal behavior. This paper also demonstrates Internet venues where reliable health information is provided to young people by health professionals. Health professionals need to recognize the hazards of adolescents Internet use, and to address potential Internet abuse when encountering adolescents in clinical settings.
Environmental exposures range across multiple domains to affect human health. In an effort to learn how environmental factors combine to contribute to health outcomes we constructed a multiple environmental domain index (MEDI) for use in health research. We used principal compone...
Makwe, Christian C; Giwa-Osagie, Osato F
Serodiscordant couples are a significant source of new HIV infection in sub-Sahara Africa. The prevention of HIV transmission to the uninfected partner should be an integral part of their health care. Serodiscordant couples desire pregnancy, treatment for infertility, effective family planning services, sexual health screening, and so on. This paper reviews the sexual and reproductive health needs of heterosexual serodiscordant couples, based on current evidence and recommendations.
Alonzo, A A
American medicine faces many contradictions and dilemmas. This is especially the case with regard to preventive health behavior. This paper explores the effects of several issues, contradictions and dilemmas on the American experience with primary preventive health behavior. These issues include: individualism, victim blaming, therapeutic nihilism, the over abundance of health information, America as a culture of risk takers, and the dilemma of the jungle vs the zoo. Four types of health behavior are defined. The first type of health behavior is the primary prevention of disease, defect, injury or disability. The second type is detection of asymptomatic disease, injury and defect. Third, is the promotion of enhanced levels of health, wellness and quality of life. And the fourth, at a more societal level, protective behaviors to make environmental transactions safe from disease, injury, defect and disability. These four types of health behavior are each explored in relation to societal values, technology and economics to determine which of these facilitate or impede health behavior at both the individual and societal levels.
The WHO (World Health Organization) definition of reproductive health establishes reproductive rights for women and men. This includes the capability to reproduce and the freedom to decide, if, when, and how often to do so. In this article the implementation of these rights in Germany is evaluated, focusing on selected aspects of family planning. Findings from empirical studies, surveys, and official registers on fertility intentions, on births, on contraception, and on abortion are compiled. Moreover, the influence of social aspects on reproductive health (education, migration background) is discussed. Records show high standards regarding information and access to contraceptives; however, more action and research are needed in three regards. First, men and women have fewer children than they would like to have, and the desire to have (more) children is deferred systematically. Second, the number and rate of abortions should be reduced. And third, more attention should be paid to social determinants that influence the access to reproductive health. Furthermore, the special needs of migrants should be taken into account.
Daniels, C R; Paul, M; Rosofsky, R
Potential exposure to occupational reproductive hazards raises complex questions regarding health and gender discrimination in the workplace. On the one hand, growing scientific evidence suggests that workplace exposures to either sex can cause a wide range of disorders ranging from infertility to adverse pregnancy outcomes. On the other hand, policies alleging to protect workers from reproductive risks have often reinforced gender inequalities in the workplace. This article sheds new light on this continuing debate through an examination of the policy insights suggested by a recent study of reproductive hazard policies in Massachusetts. In what ways do policies evidenced in this study reflect or differ from historical patterns of protectionism? The article presents a political-legal review of reproductive hazard policies in the workplace, then examines the policy implications of the Massachusetts study, and finally presents the prescriptions for change that are implied by both the historical and contemporary evidence.
From dating violence to sexting and social networking, districts are struggling to address a number of sensitive and relatively new health education issues that are aggravated by students' increasing access to computers, cell phones and other digital devices. Through new or revised curricula, administrators are attempting to deal with these and…
Thomas, Stephen B.
This monograph analyzes health and safety issues in education in terms of relevant constitutional and statutory provisions. Chapter 1, an introduction, summarizes Fourteenth Amendment equal protection and due process clauses and defines "handicapped" under the Rehabilitation Act. State assistance and student eligibility under the…
Gavert, Raymond B.
The goal has been set to establish NASA as number one in safety in the nation. This includes Systems and Mission Safety as well as Occupational Safety for all NASA employees and contractors on and off the job. There are five major health and safety issues important in the pursuit of being number one and they are: (1) Radiation (2) Hearing (3) Habitability/Toxicology (4) Extravehicular Activity (EVA) (5) Stress. The issues have features of accumulated injury since NASA's future missions involve long time human presence in space i.e., International Space Station operations and Mars missions. The objective of this paper is to discuss these five issues in terms of controlling risks and enhancing health and safety. Safety metrics are discussed in terms of the overall goal of NASA to be number one in safety. .
Zeanah, P D; Morse, E V; Simon, P M; Stock, M; Pratt, J L; Sterne, S
Despite the growing success of school-based health care during the past two decades, the issue of providing reproductive health care at school-based health centers remains controversial. In this article, focus group data from three school-based centers in Louisiana, each in different stages of development, demonstrates how the controversies about reproductive health may frame more general concerns about school-based care. In addition, community readiness to address directly problematic sexual behavior relates not only to the specific needs and priorities of the community but to recognition of the negative effect of the consequences of sexual behavior such as pregnancy, high drop out, and absenteeism rates on a community's educational, rather than social, goals and values.
Kane, Sumit; Rial, Matilda; Matere, Anthony; Dieleman, Marjolein; Broerse, Jacqueline E.W.; Kok, Maryse
Background In South Sudan, women disproportionately bear the burden of morbidity and mortality related to sexual and reproductive health, with a maternal mortality ratio of 789 deaths per 100,000 live births. Design A qualitative study was conducted to analyze how gendered social relations among the Fertit people affect women's ability to exercise control over their reproductive lives and thereby their sexual and reproductive health. Transcripts of 5 focus group discussions and 44 semi-structured interviews conducted with purposefully selected community members and health personnel were analyzed using Connell's relational theory of gender. Results Women across all age groups report that they have little choice but to meet the childbearing demands of husbands and their families. Women, both young and old, and also elders, are frustrated about how men and society are letting them down and how they are left to bear the reproductive burden. The poverty and chronic insecurity in South Sudan mean that many men have few sources of pride and achievement; conformity and complicity with the hegemonic practices accord both security and a sense of belonging and privilege to men, often at the expense of women's reproductive health. Conclusions Inequalities in the domestic, social, and economic spheres intersect to create social situations wherein Fertit women's agency in the reproductive realm is constrained. In South Sudan, as long as economic and social opportunities for women remain restricted, and as long as insecurity and uncertainty remain, many women will have little choice but to resort to having many children to safeguard their fragile present and future. Unless structural measures are taken to address these inequalities, there is a risk of both a widening of existing health inequalities and the emergence of new inequalities. PMID:27900934
In a study focusing on the views of Pakistani adolescent girls on contraception and family planning reveals that the majority of girls between the ages of 15 and 19 years have no knowledge of contraceptives. Many favor immediate pregnancy right after marriage. Only 4.8% of the total adolescent population opted to delay pregnancy and 1.5% expressed a desire to gain access to family planning aids to limit number of births. Nongovernmental organizations (NGOs) have responded to this adolescent reproductive health problem. Activities such as the Girl Child Programme, the Youth Project, and training in skills development concerned with the issue are being piloted by NGOs. In addition, non-formal education programs by the NGOs and community-based organizations have been initiated in response to the need for appropriate family life, adolescence and population education. Moreover, significant changes have been observed, brought about mainly by cultural and socioeconomic changes. Among these are the rise in the age at marriage from 16.9 to 21 years and a discernable career orientation of the education pursued by some women.
Utomo, Iwu Dwisetyani; McDonald, Peter
This study examines the changing social and political context of adolescent sexual and reproductive health policy in Indonesia. We describe how, in 2001, Indonesia was on the brink of implementing an adolescent reproductive health policy that was consistent with international agreements to which the Indonesian government was a party. Although the health of young Indonesians was known to be at risk, the opportunity for reform passed quickly with the emergence of a new competing force, Middle Eastern fundamentalist Islam. Faced with the risk of regional separatism and competing politico-religious influences, the Indonesian government retreated to the safety of inaction in this area of policy. In the absence of a supportive and committed political environment that reinforces policy specifically targeted to young people's reproductive health, extremist approaches that involve considerable health risk prevailed. The sexual and reproductive values and behaviors that are emerging among single young people in contemporary Indonesia are conditioned by a political context that allows the conflicting forces of traditional Indonesian values, Westernization, and the strong emerging force of fundamentalist Islam to compete for the allegiance of young people.
Brezina, Paul R; Shah, Anish A; Myers, Evan R; Huang, Andy; DeCherney, Alan H
For many years, health care delivery in the United States was accomplished through a complicated and evolving series of publicly and privately available insurance programs. In recent years, the increasing cost of health care as well as the relatively large number of individuals without any health care insurance coverage has prompted repeated attempts to modify or overhaul the current health care delivery paradigm. The largest legislative change to this system occurred on March 23, 2010, when President Barack Obama signed into law the Patient Protection and Affordable Care Act (PPACA).The PPACA is a multifaceted and sweeping piece of legislation. The law introduces a myriad number of changes into both public and private health insurance. Understanding the law, its implications, and how to navigate through these changes is essential to provide high-quality health care to patients. Although the law or parts of it are still at risk of being modified either through judicial or political action, it is important to recognize the current aspects of the law to understand any future modifications. Providing health care coverage in the United States is sure to be as it has always been: a constantly changing and evolving set of private and public policies that carry with them significant complexities and challenges. Health care providers must constantly strive to maximize access to and quality of medical care in whatever paradigm evolves in the future.
Lubben, Marianne; Mayhew, Susannah H.; Collins, Charles; Green, Andrew
It is not clear how policy-making in the field of reproductive health relates to changes associated with programmes for the reform of the health sector in developing countries. There has been little communication between these two areas, yet policy on reproductive health has to be implemented in the context of structural change. This paper examines factors that limit dialogue between the two areas and proposes the following framework for encouraging it: the identification of policy groups and the development of bases for collaborative links between them; the introduction of a common understanding around relevant policy contexts; reaching agreement on compatible aims relating to reproductive health and health sector change; developing causal links between policy content in reproductive health and health sector change as a basis for evidence-based policy-making; and strengthening policy-making structures, systems, skills, and values. PMID:12219159
Public Health Service (DHHS), Rockville, MD.
This report identifies a broad spectrum of issues affecting women's health and is divided into four sections: (1) social factors affecting women's health; (2) women's physical health and well-being; (3) health concerns of older women; and (4) issues related to alcohol, drug use and abuse, and the mental health of women. The Public Health Service…
Sen. Boxer, Barbara [D-CA
02/27/2013 Referred to the Committee on Health, Education, Labor, and Pensions. (text of measure as introduced: CR S947) (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:
Ramírez, Mildred; Ford, Marvella E; Stewart, Anita L; A Teresi, Jeanne
Background Racial and ethnic disparities in health and health care have been documented; the elimination of such disparities is currently part of a national agenda. In order to meet this national objective, it is necessary that measures identify accurately the true prevalence of the construct of interest across diverse groups. Measurement error might lead to biased results, e.g., estimates of prevalence, magnitude of risks, and differences in mean scores. Addressing measurement issues in the assessment of health status may contribute to a better understanding of health issues in cross-cultural research. Objective To provide a brief overview of issues regarding measurement in diverse populations. Findings Approaches used to assess the magnitude and nature of bias in measures when applied to diverse groups include qualitative analyses, classic psychometric studies, as well as more modern psychometric methods. These approaches should be applied sequentially, and/or iteratively during the development of measures. Conclusions Investigators performing comparative studies face the challenge of addressing measurement equivalence, crucial for obtaining accurate results in cross-cultural comparisons. PMID:16179000
Chin, Jean Lau; Yee, Barbara W K; Banks, Martha E
As health care reform promises to change the landscape of health care delivery, its potential impact on women's health looms large. Whereas health and mental health systems have historically been fragmented, the Affordable Care Act (ACA) mandates integrated health care as the strategy for reform. Current systems fragment women's health not only in their primary care, mental health, obstetrical, and gynecological needs, but also in their roles as the primary caregivers for parents, spouses, and children. Changes in reimbursement, and in restructuring financing and care coordination systems through accountable care organizations and medical homes, will potentially improve women's health care.
Schrader, Steven M; Marlow, Katherine L
The earliest report linking environmental (occupational) exposure to adverse human male reproductive effects dates back to1775 when an English physician, Percival Pott, reported a high incidence of scrotal cancer in chimney sweeps. This observation led to safety regulations in the form of bathing requirements for these workers. The fact that male-mediated reproductive harm in humans may be a result of toxicant exposures did not become firmly established until relatively recently, when Lancranjan studied lead-exposed workers in Romania in 1975, and later in 1977, when Whorton examined the effects of dibromochloropropane (DBCP) on male workers in California. Since these discoveries, several additional human reproductive toxicants have been identified through the convergence of laboratory and observational findings. Many research gaps remain, as the pool of potential human exposures with undetermined effects on male reproduction is vast. This review provides an overview of methods used to study the effects of exposures on male reproduction and their reproductive health, with a primary emphasis on the implementation and interpretation of human studies. Emphasis will be on occupational exposures, although much of the information is also useful in assessing environmental studies, occupational exposures are usually much higher and better defined. PMID:24369130
Harrison, P. F.; Hemmerling, A.; Romano, J.; Whaley, K. J.; Young Holt, B.
Women worldwide confront two frequently concurrent reproductive health challenges: the need for contraception and for protection from sexually transmitted infections, importantly HIV/AIDS. While conception and infection share the same anatomical site and mode of transmission, there are no reproductive health technologies to date that simultaneously address that reality. Relevant available technologies are either contraceptive or anti-infective, are limited in number, and require different modes of administration and management. These “single-indication” technologies do not therefore fully respond to what is a substantial reproductive health need intimately linked to pivotal events in many women's lives. This paper reviews an integrated attempt to develop multipurpose prevention technologies—“MPTs”—products explicitly designed to simultaneously address the need for both contraception and protection from sexually transmitted infections. It describes an innovative and iterative MPT product development strategy with the following components: identifying different needs for such technologies and global variations in reproductive health priorities, defining “Target Product Profiles” as the framework for a research and development “roadmap,” collating an integrated MPT pipeline and characterizing significant pipeline gaps, exploring anticipated regulatory requirements, prioritizing candidates for problem-solving and resource investments, and implementing an ancillary advocacy agenda to support this breadth of effort. PMID:23533733
Devlin, Nancy; Parkin, David
The appropriate level and source of funds for assisted reproduction technologies (ARTs), in particular IVF, have been controversial in most developed economies. Funding of fertility services internationally is characterized by low public (or other third party) funding, a greater reliance on user-pays than in most other health services, and variations in funding and provision. This article describes the characteristics of infertility as a condition and its treatment that have been used as a rationale for its exclusion from an otherwise comprehensive coverage of health services. The challenges these characteristics pose for the use of economic evaluation to inform resource allocation are discussed. Most economic evaluations have focused on the cost effectiveness of alternative infertility treatments. These evaluations provide important information, but do not inform the real issue at stake: what is the appropriate allocation of funds to ARTs, given that it involves sacrificing improvements in health in other areas? Cost utility analysis - the method of economic appraisal preferred by most agencies charged with making such decisions (including the National Institute of Clinical Excellence in the UK) - is ill-equipped to deal with the benefits produced by ARTs. Alternative methods are available, but require decision makers to weigh up very different sorts of evidence. Demonstration of the willingness to pay for the benefits of ARTs can be used to support public decisions but, conversely, also implies that those who can pay will pay in a private market. Ultimately, decisions about the inclusion or otherwise of ARTs in collectively funded health systems probably rest as much on judgments about equity in access as value for money. Given that this is the case, public funding of IVF should be accompanied by the development of agreed criteria for the prioritization of potential recipients, to ensure treatment is targeted at those for whom it is most effective and that access
This article explores the issue of conscientious objection invoked by health professionals in the reproductive and sexual health care context and its impact on women's ability to access health services. The right to exercise conscientious objection has been recognized by many international and European scholars as being derived from the right to freedom of thought, conscience and religion. It is not, however, an absolute right. When the exercise of conscientious objection conflicts with other human rights and fundamental freedoms, a balance must be struck between the right to conscientious objection and other affected rights such as the right to respect for private life, the right to equality and non-discrimination, and the right to receive and impart information. Particularly in the reproductive health care context, states that allow health professionals to exercise conscientious objection must accommodate this in such a way that its exercise does not compromise women's access to health services. This article analyses the European Court of Human Rights' decision on admissibility in Pichon and Sajous v. France (2001) and argues that a balancing approach should be applied in cases of conscientious objection in the sexual and reproductive health care context.
Sebo, Paul; Jackson, Yves; Haller, Dagmar M; Gaspoz, Jean-Michel; Wolff, Hans
Undocumented migrants face major barriers in accessing prevention and health care. Whereas the association between low socioeconomic status and poor health is well documented only few studies have addressed specific health issues in undocumented migrants. The aim of the present study is to describe sexual and reproductive health behaviors of undocumented migrants in Geneva. This descriptive cross sectional study included consecutive undocumented migrants presenting from November 2007 to February 2008 to a health facility offering free access to health care to this population. Following informed consent, they completed a self administered questionnaire about their socio-demographic profile and sexual and reproductive health behaviors. A total of 384 patients were eligible for the study. 313 (82%) agreed to participate of which 77% (241 patients) completed the survey. Participants were mainly young, Latino-American, single, well-educated and currently working women. They had multiple partners and reported frequently engaging in sexual intercourse. Use of contraceptive methods and strategies of prevention against sexually transmitted infections (STI) were rare. Nearly half of the women had had at least one induced abortion and 40% had had an unplanned pregnancy. One in four participants reported a current or past STI or other genital infection. The results of our study suggest that undocumented migrants engage in frequent and high risk sexual intercourse with insufficient use of contraceptive methods and suboptimal strategies of prevention against STI. Our study underlines the real need for specific sexual and reproductive educational programs targeting this hard to reach population.
Osteen, Kathryn A; Beal, Claudia C
The purpose of this article was to examine reproductive health issues for women with congenital structural abnormalities of the heart. Because of surgical advances and innovations in healthcare, infants with congenital heart disease often live now into adulthood. Women with congenital heart disease have reported the desire to have children but expressed concern about fertility and the health consequences of pregnancy. Although many women with congenital heart disease are able to give birth without adverse outcomes, life-threatening complications can occur. Best practices for the care of women with congenital heart disease are grounded in an understanding of how cardiac defects may affect pregnancy and in communicating the implications of cardiac defects for reproductive health to support informed decision making.
Ljubin-Sternak, Sunčanica; Meštrović, Tomislav
The most prevalent, curable sexually important diseases are those caused by Chlamydia trachomatis (C. trachomatis) and genital mycoplasmas. An important characteristic of these infections is their ability to cause long-term sequels in upper genital tract, thus potentially affecting the reproductive health in both sexes. Pelvic inflammatory disease (PID), tubal factor infertility (TFI), and ectopic pregnancy (EP) are well documented complications of C. trachomatis infection in women. The role of genital mycoplasmas in development of PID, TFI, and EP requires further evaluation, but growing evidence supports a significant role for these in the pathogenesis of chorioamnionitis, premature membrane rupture, and preterm labor in pregnant woman. Both C. trachomatis and genital mycoplasmas can affect the quality of sperm and possibly influence the fertility of men. For the purpose of this paper, basic, epidemiologic, clinical, therapeutic, and public health issue of these infections were reviewed and discussed, focusing on their impact on human reproductive health. PMID:25614838
Cáceres, C; Cueto, M; Palomino, N
This study is aimed at examining how subsequent Peruvian governments, since 1990, have addressed reproductive rights, HIV/AIDS prevention and treatment, and sexual diversity rights, as well as the drastic policy shifts and its many contradictions. Abortion and contraception consistently generated the deepest public controversies and debates, which made progress in reproductive rights difficult. HIV/AIDS was often portrayed as having the potential to affect everyone, which allowed advocates and activists to achieve some success in advancing HIV/AIDS-related rights. Sexual diversity rights, perceived as a demand made by "others", were generally trivialised and disdained by politicians, officials, and the general population. Positive changes occurred as long as the issue was given a low political and institutional profile. The analysis of policy-making and programme implementation in these three areas reveals that: (1) Weaknesses in national institutional frameworks concerning reproductive health made it possible for governments to adopt two very different (even contradictory) approaches to the issue within the past 15 years; (2) Policies were presented as rights-based in order to garner political legitimacy when, in fact, they evidenced a clear disregard for the rights of individual citizens; and (3) By favouring low-profile "public health" discourses, and marginalising "the sexual" in official policies related to sexuality, advocacy groups sometimes created opportunities for legal changes but failed to challenge conservative powers opposing the recognition of sexual and reproductive rights and the full citizenship of women and sexual minorities.
Challis, John R G
The 59th Annual Meeting of the Society for Gynecologic Investigation was held in San Diego, (CA, USA) on 21-24 March 2012, with a record number of registrants (over 1300) and submitted abstracts. The main 3-day meeting was preceded by a day of satellite meetings, covering topics such as placental function, endometrial bleeding and global issues for preterm birth. The meeting was opened by the President of the Society for Gynecologic Investigation for 2011-2012, Stephen J Lye, from the University of Toronto (ON, Canada), with 13 past presidents of the society (including this writer) in attendance.
Global debate on required policy responses to issues of older persons has intensified over the past 15 years, fuelled by a growing awareness of the rapid ageing of populations. Health has been a central focus, but scrutiny of global policies, human rights instruments and reports reveals that just as older people are excluded from sexual and reproductive health and rights agendas, so are issues of sexual and reproductive health and rights wholly marginal to current agendas focused on older people. A critical question is whether the policy lacuna reflects a dearth of research evidence or a faulty translation of existing knowledge. A reading of the current research landscape and literature, summarised in this paper, strongly suggests it is the former. To be sure, sexuality in old age is a burgeoning field of scientific inquiry. What the existing knowledge and discourse fail to provide is an engagement with, and elucidation of, the broader sexual and reproductive health and rights agenda as it relates to older persons. A concerted research effort is needed to provide a basis for developing policy guidance and for pinpointing essential indicators and establishing necessary data systems to enable a routine tracking of progress.
This paper briefly examines the impact on reproductive health of social inequalities and poverty in Latin America and the Caribbean. The need to improve the quality of health services and to develop appropriate programs that promote reproductive rights is emphasized.
Murphy, Devin; Klosky, James L; Reed, Damon R; Termuhlen, Amanda M; Shannon, Susan V; Quinn, Gwendolyn P
Visions for the future are a normal developmental process for adolescents and young adults (AYAs) with and without cancer, and these visions often include expectations of sexual and romantic relationships. AYA cancer survivors indicate reproductive health is an issue of great importance and more attention is needed in the health care setting throughout the cancer experience, beginning at diagnosis. Various practice guidelines are predominately focused on fertility; are intended to influence survivorship care plans; and do not encompass the broad scope of reproductive health that includes romantic partnering, friendships, body image, sexuality, sexual identity, fertility, contraception, and more. Although interventions to reduce reproductive health-related sequelae from treatment are best approached as an evolving process, practitioners are not certain of the priorities of these various reproductive health content areas. Strategies incongruent with the reproductive health priorities of AYAs will likely thwart adequate follow-up care and foster feelings of isolation from the treatment team. Research is needed to identify these priorities and ensure discussions of diverse content areas. This review explored various domains of reproductive health and emphasized how understanding the priorities of the AYA cancer cohort will guide future models of care.
Agampodi, Suneth B; Agampodi, Thilini C; UKD, Piyaseeli
Background Adolescent health needs, behaviours and expectations are unique and routine health care services are not well geared to provide these services. The purpose of this study was to explore the perceived reproductive health problems, health seeking behaviors, knowledge about available services and barriers to reach services among a group of adolescents in Sri Lanka in order to improve reproductive health service delivery. Methods This qualitative study was conducted in a semi urban setting in Sri Lanka. A convenient sample of 32 adolescents between 17–19 years of age participated in four focus group discussions. Participants were selected from four midwife areas. A pre-tested focus group guide was used for data collection. Male and female facilitators conducted discussions separately with young males and females. All tape-recorded data was fully transcribed and thematic analysis was done. Results Psychological distresses due to various reasons and problems regarding menstrual cycle and masturbation were reported as the commonest health problems. Knowledge on existing services was very poor and boys were totally unaware of youth health services available through the public health system. On reproductive Health Matters, girls mainly sought help from friends whereas boys did not want to discuss their problems with anyone. Lack of availability of services was pointed out as the most important barrier in reaching the adolescent needs. Lack of access to reproductive health knowledge was an important reason for poor self-confidence among adolescents to discuss these matters. Lack of confidentiality, youth friendliness and accessibility of available services were other barriers discussed. Adolescents were happy to accept available services through public clinics and other health infrastructure for their services rather than other organizations. A demand was made for separate youth friendly services through medical practitioners. Conclusions and recommendations
Englberger, Lois; Lorens, Adelino; Guarino, Luigi; Taylor, Mary; Snowdon, Wendy; Maddison, Marie; Mieger, Judy; Thomson, Lex; Lippwe, Kipier; Rimon, Betarim; Fitzgerald, Maureen H; Tibon, Jorelik; Sohhrab, Sepehr; Ehmes, Okean; Rally, Jim; Shed, Patterson
Neglect of traditional food systems has led to serious nutrition and health problems throughout the Pacific Islands. At the same time, there is concern about the loss of traditional knowledge, customs and culture related to local foods, and of biodiversity. However, there is still a great diversity of nutrient-rich local food crops in the Pacific, along with considerable knowledge about these foods, their methods of production, harvesting, storage, and preparation. An integrated approach is needed in order to make a meaningful impact on increased production, marketing/processing and use of local food crops and foods for better health and nutrition, requiring greater collaboration between the health sector and agencies in other sectors. Priorities for action include: documentation and assessment of traditional food systems, including analysis of local foods and crop varieties for their nutrient content; innovative means of increasing awareness of the values of local foods among the general public and policy makers; conservation of rare varieties of crops and food trees and protection of the environment; and an increased focus on small-scale processing and marketing of local foods. Overriding all of this is the urgent need to mainstream consideration of these important issues into relevant national and regional policies. The rubric "Biodiversity for Health and Nutrition" incorporates all of these issues and provides a framework within which all partner agencies can be involved.
Two reproductive health advocacy networks have been established in two districts in eastern Africa to help promote family planning and reproductive health among the people in this area. The districts are the Suhum-Kraboa-Coaltar and the New Juaben Municipality. To enhance the performance of the network, a 4-day workshop was held at Koforidua for the members to prepare an action plan for their advocacy and map out areas of collaboration between the public and the private sector group. The workshop, organized by the Futures Group International based in the US with support from the USAID, was attended by 30 participants from nongovernmental organizations and public offices. In an address, Ms. Patience Adow, the Regional Minister observed that through the idea of family planning has been promoted in the country over the past two decades, the country continues to experience a population growth rate of about 2.8%. She expressed the hope that the workshop will equip the participants with the relevant skills to develop and implement their advocacy strategy effectively. Dr. J. E. Taylor, Medical Administrator of the Koforidua Central Hospital, who chaired the function in a bid to improve the health of women and the quality of life of the people. The Ministry of Health as part of its medium term strategic plan has developed the national reproductive health and service policy.
The population's high growth rate, age profile, and geographical distribution have aroused increasing public concern in Paraguay. The country is involved in a moderate demographic transition, compatible with the consequences of modernity and the uneven rate of both social and economic changes. Reduction of mortality and the persistence of high birth rate patterns result in an age structure that consolidates demographic growth, with an increased focus on the dependent population. In the late 1960s the need for a systematic approach to population problems was perceived within the framework of economic planning. National governments had, and currently have, an ambivalent perception of this issue, since population growth is simply considered a positive factor. This concept results from an economic view of the consequences of a reduced domestic market in absolute terms. The lack of a Development Plan, the management deficit, and the shortage of training leave doubts as to the establishment of organically connected policies or programs concerning population.
The Latin American and Caribbean Seminar on Women's Health and Reproductive Rights was held in Brasilia on November 13-14, 1991. The seminar manifesto reproduced here cities the many ways in which women in the region are oppressed by poverty and social injustice, and points to Cuba as a country where health and reproductive rights are respected. Latin American has been oppressed for 500 years. Its population still experiences misery, poverty, and deprivation of human rights and an equitable quality of life. The poor, especially women and children, are being decimated by endemic disease, mass sterilization, sexual and racial discrimination, and expropriation of liberty and the freedom to make choices concerning their own countries and bodies. The situation has resulted from the neoliberal policies of the latin American governments with the exception of Cuba. The international policy has called for renunciation of national sovereignty and submission to imperialist policy. social programs have suffered particularly. Women in Latin American are not considered 1st class in all stages of their lives. The Seminar of Women's Health and Reproductive Rights signals the urgent need to improve the situation through measures to mobilize society in defence of health and reproductive rights. High indices of maternal mortality caused largely by illegal abortion, premature births and perinatal deaths, lack of prenatal care, malnutrition, generalized violence, prostitution of minors and adolescents, psychic disturbances from limitations and deformations in the exercise of sexuality, lack of choice of contraceptive methods, surgical sterilization at a young age, excess numbers of cesareans, high-technology medical interventions motivated by economic interest, lack of sex education, and shortcomings of preventive health policies and basic public services are among the problems affecting Latin American women. Cuba is hailed as a country where women can freely choose abortion, and where
McMichael, Anthony J; Butler, Colin D
The spectrum of tasks for health promotion has widened since the Ottawa Charter was signed. In 1986, infectious diseases still seemed in retreat, the potential extent of HIV/AIDS was unrecognized, the Green Revolution was at its height and global poverty appeared less intractable. Global climate change had not yet emerged as a major threat to development and health. Most economists forecast continuous improvement, and chronic diseases were broadly anticipated as the next major health issue. Today, although many broadly averaged measures of population health have improved, many of the determinants of global health have faltered. Many infectious diseases have emerged; others have unexpectedly reappeared. Reasons include urban crowding, environmental changes, altered sexual relations, intensified food production and increased mobility and trade. Foremost, however, is the persistence of poverty and the exacerbation of regional and global inequality. Life expectancy has unexpectedly declined in several countries. Rather than being a faint echo from an earlier time of hardship, these declines could signify the future. Relatedly, the demographic and epidemiological transitions have faltered. In some regions, declining fertility has overshot that needed for optimal age structure, whereas elsewhere mortality increases have reduced population growth rates, despite continuing high fertility. Few, if any, Millennium Development Goals (MDG), including those for health and sustainability, seem achievable. Policy-makers generally misunderstand the link between environmental sustainability (MDG #7) and health. Many health workers also fail to realize that social cohesion and sustainability--maintenance of the Earth's ecological and geophysical systems--is a necessary basis for health. In sum, these issues present an enormous challenge to health. Health promotion must address population health influences that transcend national boundaries and generations and engage with the
Lin, Lan-Ping; Lin, Pei-Ying; Chu, Cordia M.; Lin, Jin-Ding
Although many previous studies have begun to address the reproductive health needs of women with intellectual disabilities; however, the supportive behaviors of caregivers to assist their reproductive health is not well understood. Data from a cross-sectional survey of ""2009 National Survey on Reproductive Health Care Needs and Health…
Kapinga, Orestes Silverius; Hyera, Daniel Frans
This study explored pupils' perceptions of sex and reproductive health education in primary schools in Tanzania. Specifically, the study aimed at (i) exploring pupils' views on sex and reproductive health education in primary schools; (ii) determining opinions on the appropriateness of sex and reproductive health education for pupils in primary…
During the first decade of the 21st century a new "dramatic story" about the growing global surrogacy industry brought renewed attention to surrogacy as a social problem and a health policy issue. This paper asks: What cultural assumptions about gender, family and the global reproductive health market are revealed in current U.S. media coverage of and public discourses about surrogacy? From a qualitative analysis of prominent news accounts of surrogacy that were published in 2008, New York Times articles and blogs published on the topic between 2006 and 2010, and over 1000 online reader comments to these articles, I identify key frames used to discursively construct and debate the international surrogacy market. This study reveals the distinct contrast between the occasions when reproductive labor is rhetorically distanced from commodification processes and when it is linked to those processes. The findings contribute to intersectional analyses of assisted reproductive practices and women's health/bodies/gametes. In particular, this study's analysis of recent media framings of and public discourses about surrogacy across the globe serves as another illustration that national/classed/racialized bodies continue to be reproductively stratified via differently gendered discourses about women, motherhood and family.
Coates, Amy L; Hill, Peter S; Rushton, Simon; Balen, Julie
The Holy See has engaged extensively in United Nations negotiations on issues concerning sexual and reproductive health rights as they have emerged and evolved in a dynamic global agenda over the past two decades. A meta-narrative review of the mission's official statements was conducted to examine the positions, discourses and tensions across the broad range of agendas. The Holy See represents a fundamentally conservative and stable position on a range of sexual and reproductive health rights concerns. However, the mission has been dynamic in the ways in which it has forwarded its arguments, increasingly relying upon secularised technical claims and empirical evidence; strategically interpreting human rights norms in ways consistent with its own position; and framing sexuality and reproduction in the context of "the family". Seen in the broader context of a "religious resurgence" in international relations, and in light of the fact that the Holy See has frequently sought to form alliances with conservative State and non-State actors, these findings make an important contribution to understanding the slow progress as well as the potential obstacles that lie ahead in the battle to realise sexual and reproductive health rights in a changing global political environment.
Lasley, B L; Overstreet, J W
Identification of environmental hazards to reproductive health and characterization of the adverse outcomes necessitate a multidisciplinary approach. Epidemiologic studies are required for the identification of adverse health effects in human populations and then to confirm that specific exposures are responsible. Clinical studies are required to develop assays for reproductive biomarkers and to validate these assays prior to their application in the field. Assays for field use must be formatted and streamlined for large-scale applications and, whenever possible, computer algorithms should be developed to interpret biomarker data. Appropriate animal models must be identified, biomarker assays validated for that model, and animal experiments conducted to identify the mode of action and target organ of a putative reproductive toxicant. Finally, in vitro studies at the level of the cell and cell organelle are essential for mechanisms for toxicity to be clearly identified and understood. In this article we describe the interdisciplinary approach that we have developed for study of the effects of environmental agents on female reproductive functions. This effort requires specific skills of toxicologists, epidemiologists, physicians, biochemists, and physiologists. PMID:9703478
Mastromarino, P.; Hemalatha, R.; Barbonetti, A.; Cinque, B.; Cifone, M.G.; Tammaro, F.; Francavilla, F.
The human vaginal microbiota plays an important role in the maintenance of a woman's health, as well as of her partner's and newborns’. When this predominantly Lactobacillus community is disrupted, decreased in abundance and replaced by different anaerobes, bacterial vaginosis (BV) may occur. BV is associated with ascending infections and obstetrical complications, such as chorioamnionitis and preterm delivery, as well as with urinary tract infections and sexually transmitted infections. In BV the overgrowth of anaerobes produces noxious substances like polyamines and other compounds that trigger the release of pro-inflammatory cytokines interleukin (IL)-1 β and IL-8. BV can profoundly affect, with different mechanisms, all the phases of a woman's life in relation to reproduction, before pregnancy, during fertilization, through and at the end of pregnancy. BV can directly affect fertility, since an ascending dissemination of the involved species may lead to tubal factor infertility. Moreover, the increased risk of acquiring sexually transmitted diseases contributes to damage to reproductive health. Exogenous strains of lactobacilli have been suggested as a means of re-establishing a normal healthy vaginal flora. Carefully selected probiotic strains can eliminate BV and also exert an antiviral effect, thus reducing viral load and preventing foetal and neonatal infection. The administration of beneficial microorganisms (probiotics) can aid recovery from infection and restore and maintain a healthy vaginal ecosystem, thus improving female health also in relation to reproductive health. PMID:25673551
Langer, A.; Nigenda, G.; Catino, J.
Many countries in Latin America and the Caribbean (LAC) are currently reforming their national health sectors and also implementing a comprehensive approach to reproductive health care. Three regional workshops to explore how health sector reform could improve reproductive health services have revealed the inherently complex, competing, and political nature of health sector reform and reproductive health. The objectives of reproductive health care can run parallel to those of health sector reform in that both are concerned with promoting equitable access to high quality care by means of integrated approaches to primary health care, and by the involvement of the public in setting health sector priorities. However, there is a serious risk that health reforms will be driven mainly by financial and/or political considerations and not by the need to improve the quality of health services as a basic human right. With only limited changes to the health systems in many Latin American and Caribbean countries and a handful of examples of positive progress resulting from reforms, the gap between rhetoric and practice remains wide. PMID:10859860
Collins, C; Araujo, J; Barbosa, J
The health sector in Brazil has undergone important changes, particularly with the development of the Unified Health System (SUS). Decentralisation is an important principle of SUS and advances have been made in transferring responsibilities and resources to the local government units, known as municipios. This article describes the changes introduced, focusing on the system of municipio classification and the funding mechanisms introduced through the basic operating rule (BOR) of 1996. The paper then moves on to analysing three key issues of decentralisation in Brazil that are related to the policy process, the system of decentralisation and the output of decentralisation. Firstly, the formal process by which decisions on health sector reform are made is discussed with particular attention being paid to the negotiated and relatively open policy space. Secondly, the role of the states is discussed within the decentralised system. Thirdly, the impact of decentralisation on equity is discussed with particular reference to the resourcing of the Municipal Health Funds. The article concludes by emphasising the political nature of health sector decentralisation and the need to develop the conditions for effectiveness in decentralisation programmes.
Major conclusions and recommendations of the National Commission on Air Quality on issues of health in the Clean Air Act are presented. The issues revolve mainly about the standard setting processes for ubiquitous pollutants, controlled through ambient air quality standards (Section 109), and for hazardous pollutants controlled through emission standards (Section 112). The conceptual difficulties inherent in the terms "adequate margin of safety" (Section 109) and "ample margin of safety" (Section 112) are discussed. The Clean Air Science Advisory Committee is widely viewed as having a salutary effect on standard setting. The need for maintaining strong research capabilities within the Environmental Protection Agency that are reasonably buffered against sudden disruptive events is emphasized. Mechanisms for achieving this goal through special congressional appropriations are considered. PMID:6653527
The focus of the May-June issue is on outage management and health physics. Major articles/reports in this issue include: A design with experience for the U.S., by Michael J. Wallace, Constellation Generation Group; Hope to be among the first, by Randy Hutchinson, Entergy Nuclear; Plans to file COLs in 2008, by Garry Miller, Progress Energy; Evolution of ICRP's recommendations, by Lars-Erik Holm, ICRP; European network on education and training in radiological protection, by Michele Coeck, SCK-CEN, Belgium; Outage managment: an important tool for improving nuclear power plant performance, by Thomas Mazour and Jiri Mandula, IAEA, Austria; and Plant profile: Exploring new paths to excellence, by Anne Thomas, Exelon Nuclear.
Current issues in medically assisted reproduction and genetics in Europe: research, clinical practice, ethics, legal issues and policy. European Society of Human Genetics and European Society of Human Reproduction and Embryology.
Harper, Joyce C; Geraedts, Joep; Borry, Pascal; Cornel, Martina C; Dondorp, Wybo; Gianaroli, Luca; Harton, Gary; Milachich, Tanya; Kääriäinen, Helena; Liebaers, Inge; Morris, Michael; Sequeiros, Jorge; Sermon, Karen; Shenfield, Françoise; Skirton, Heather; Soini, Sirpa; Spits, Claudia; Veiga, Anna; Vermeesch, Joris Robert; Viville, Stéphane; de Wert, Guido; Macek, Milan
In March 2005, a group of experts from the European Society of Human Genetics and European Society of Human Reproduction and Embryology met to discuss the interface between genetics and assisted reproductive technology (ART), and published an extended background paper, recommendations and two Editorials. Seven years later, in March 2012, a follow-up interdisciplinary workshop was held, involving representatives of both professional societies, including experts from the European Union Eurogentest2 Coordination Action Project. The main goal of this meeting was to discuss developments at the interface between clinical genetics and ARTs. As more genetic causes of reproductive failure are now recognised and an increasing number of patients undergo testing of their genome before conception, either in regular health care or in the context of direct-to-consumer testing, the need for genetic counselling and preimplantation genetic diagnosis (PGD) may increase. Preimplantation genetic screening (PGS) thus far does not have evidence from randomised clinical trials to substantiate that the technique is both effective and efficient. Whole-genome sequencing may create greater challenges both in the technological and interpretational domains, and requires further reflection about the ethics of genetic testing in ART and PGD/PGS. Diagnostic laboratories should be reporting their results according to internationally accepted accreditation standards (International Standards Organisation - ISO 15189). Further studies are needed in order to address issues related to the impact of ART on epigenetic reprogramming of the early embryo. The legal landscape regarding assisted reproduction is evolving but still remains very heterogeneous and often contradictory. The lack of legal harmonisation and uneven access to infertility treatment and PGD/PGS fosters considerable cross-border reproductive care in Europe and beyond. The aim of this paper is to complement previous publications and provide
Rosenblatt, R A; Robinson, K B; Larson, E H; Dobie, S A
This paper investigated the attitude toward abortion and other reproductive health services of first- and second-year medical students at the Seattle campus of the University of Washington, a large regional primary care-oriented medical school, in 1996-97. A total of 219 (76.6%) students responded. The majority of the students support the availability of a broad range of reproductive health services including abortion; 58.1% felt that first-trimester abortions should be available to patients under most circumstances. Of the 43.4% of students who anticipated a career in family practice, most expected to provide abortions in their future practices. Moreover, older students and women were more likely to support the provision of abortion services. This study concludes that despite the continuing pressure on abortion providers, most first- and second-year medical students at a fairly state-supported medical school intend to incorporate this procedure into their future practices.
Jiloha, R C
Rape of women by men has occurred throughout recorded history and across cultures and religions. It is a crime against basic human right and a most common crime against women in India. In this article, rape is discussed from legal and mental health perspective. In India 'rape laws' began with enactment of Indian Penal Code in 1860. There have been subsequent amendments and the main issue of focus remained the definition of 'rape and inclusion of 'marital rape' in the ambit of rape. Law Commission Reports related to rape and the psychological impacts of rape have been discussed.
The focus of the May-June issue is on outage management and health physics. Major articles include: Outage optimization initiatives, by George B. Beam, AREVA NP, Inc.; New plant based on excellent track records, by Jim Scarola, Progress Energy; Meeting customer needs and providing environmental benefits, by Peter S. Hastings, Duke Energy; Plants with 3-D design, by Jack A. Bailey, Tennessee Valley Authority; and Highest quality with exceptional planning, by Jason A. Walls, Duke Energy. Industry innovation articles include: Integrated exposure reduction plan, by Ed Wolfe, Exelon; Performance-based radiation worker training, by Joe Giuffre and Timothy Vriezerma, American Electric Power.
Yasumura, Seiji; Abe, Masafumi
After the Great East Japan Earthquake on March 11, 2011, the Tokyo Electric Power Company Fukushima Daiichi Nuclear Power Plant accident occurred. The Fukushima prefectural government decided to launch the Fukushima Health Management Survey; Fukushima Medical University was entrusted to design and implement the survey. The survey process and development is described from the standpoint of its background and aim. An overview of the basic survey and 4 detailed surveys is briefly provided. Issues related to the survey are discussed from the perspective of supporting the Fukushima residents.
Walker, Kelly; Arbour, Megan; Waryold, Justin
Graduate medical, nursing, and midwifery curricula often have limited amounts of time to focus on issues related to cultural competency in clinical practice, and respectful sexual and reproductive health care for all individuals in particular. Respectful health care that addresses sexual and reproductive concerns is a right for everyone, including those who self-identify as lesbian, gay, bisexual, or transgender (LGBT). LGBT persons have unique reproductive health care needs as well as increased risks for poor health outcomes. Both the World Health Organization and Healthy People 2020 identified the poor health of LGBT persons as an area for improvement. A lack of educational resources as well as few student clinical experiences with an LGBT population may be barriers to providing respectful sexual and reproductive health care to LGBT persons. This article offers didactic educational strategies for midwifery and graduate nursing education programs that may result in reducing barriers to the provision of respectful sexual and reproductive health care for LGBT clients. Specific ideas for implementation are discussed in detail. In addition to what is presented here, other educational strategies and clinical experiences may help to support students for caring for LGBT persons prior to entrance into clinical practice.
Aitken, Robert J; Smith, Tegan B; Jobling, Matthew S; Baker, Mark A; De Iuliis, Geoffry N
One of the major causes of defective sperm function is oxidative stress, which not only disrupts the integrity of sperm DNA but also limits the fertilizing potential of these cells as a result of collateral damage to proteins and lipids in the sperm plasma membrane. The origins of such oxidative stress appear to involve the sperm mitochondria, which have a tendency to generate high levels of superoxide anion as a prelude to entering the intrinsic apoptotic cascade. Unfortunately, these cells have very little capacity to respond to such an attack because they only possess the first enzyme in the base excision repair (BER) pathway, 8-oxoguanine glycosylase 1 (OGG1). The latter successfully creates an abasic site, but the spermatozoa cannot process the oxidative lesion further because they lack the downstream proteins (APE1, XRCC1) needed to complete the repair process. It is the responsibility of the oocyte to continue the BER pathway prior to initiation of S-phase of the first mitotic division. If a mistake is made by the oocyte at this stage of development, a mutation will be created that will be represented in every cell in the body. Such mechanisms may explain the increase in childhood cancers and other diseases observed in the offspring of males who have suffered oxidative stress in their germ line as a consequence of age, environmental or lifestyle factors. The high prevalence of oxidative DNA damage in the spermatozoa of male infertility patients may have implications for the health of children conceived in vitro and serves as a driver for current research into the origins of free radical generation in the germ line. PMID:24369131
Ports, Katie A; Barnack-Tavlaris, Jessica L; Mosavel, Maghboeba; Murithi, Lydia Karuta
In the present study the authors sought to explore, in greater depth, the impact that HPV vaccination has on college-aged women's reproductive and sexual health. Qualitative interviews were conducted with 30 HPV-vaccinated, college women and analyzed for reoccurring themes. Although findings revealed that women's HPV-related knowledge was suboptimal, most women correctly believed that they were still at risk for HPV after having received the vaccination. Women indicated that having the HPV vaccine made them more aware of sexually transmitted infections and prompted them to continue to take care of their sexual health. Women reported that having the HPV vaccine did not influence their condom use or birth control choices, and they believed that obtaining Pap smears was still important. These results help us to understand the impact of HPV vaccination on women's reproductive and sexual health. These findings are promising and reinforce the importance of educating women about behaviors that will help them maintain reproductive and sexually healthy lives.
Mairiga, Abdulkarim Garba; Geidam, Ado Dan'azumi; Bako, Babagana; Ibrahim, Abdullahi
The objective of this study was to determine the knowledge and attitudes of practicing Nigerian lawyers towards issues relating to reproductive health and reproductive rights, and their opinions about abortion law reform. It was a population- based study which consisted of interviews with practicing lawyers in north-east Nigeria. The results showed poor knowledge of issues related to reproductive health and reproductive rights among the lawyers. However, the majority (56.9%) disagreed that a woman can practice family planning without the consent of her husband. The prevalence of contraceptive use among the lawyers was low and attitude to abortion law not satisfactory. Only few lawyers (22.4%) supported safe abortion in cases of failed contraception. We conclude that reproductive health advocates must target legal professionals with a view to educating them on issues relating to sexual and reproductive health and rights. Lawyers in Nigeria should undergo capacity building in reproductive health laws and be encouraged to specialize in reproductive rights protection as obtainable in other developed countries.
Ilgen, Daniel R.
Discusses why health issues should be addressed, and why industrial/organizational psychologists should address these issues in the workplace. Presents five models for addressing health at work. Explores health-related criteria as sources for studying and developing programs concerning health. Discusses responses to health at work on an individual…
Hill, Peter S; Dodd, Rebecca; Dashdorj, Khurelmaa
Since its transition to democracy, Mongolia has undergone a series of reforms, both at national level and in the health sector. This paper examines the pace and scope of these reforms, the ways in which they have impacted on sexual and reproductive health services and their implications for the health workforce. Formerly pro-natalist, Mongolia has made significant advances in contraceptive use, women's education and reductions in maternal mortality. However, rising adolescent pregnancy and sexually transmitted infections, and persisting high levels of abortion, remain challenges. The implementation of the National Reproductive Health Programme has targeted skills development, outreach and the provision of resources. Innovative adolescent-friendly health services have engaged urban youth, and the development of family group practices has created incentives to provide primary medical care for marginalised communities, including sexual and reproductive health services. The Health Sector Strategic Masterplan offers a platform for coordinated development in health, but is threatened by a lack of consensus in both government and donor communities, competing health priorities and the politicisation of emerging debates on fertility and abortion. With previous gains in sexual and reproductive health vulnerable to political change, these tensions risk the exacerbation of existing disparities and the development by default of a two-tiered health care system.
Webber, Gail C; Spitzer, Denise L; Somrongthong, Ratana; Dat, Truong Cong; Kounnavongsa, Somphone
Migrant beer promoters in Cambodia, Laos, Thailand, and Vietnam were surveyed to determine their experiences in accessing reproductive health care services in the cities of Phnom Penh, Vientiane, Bangkok, and Hanoi. A total of 7 health care institutions were chosen as popular with migrant beer promoters. Staff at these institutions provided information on the institution, and 390 beer promoters were surveyed about their experiences while accessing services. There were discrepancies between findings from the staff interviews and the experiences of the beer promoters. In general, the migrant women were satisfied with the cost, location, friendliness of the health care providers, and knowledge and skills of the providers. They were less positive about confidentiality and waiting times, though many still agreed that these were not an issue. Health care planners and providers should take note of the issues affecting access to reproductive health care services for migrant women when they design and implement services.
Webber, Gail C.; Spitzer, Denise L.; Somrongthong, Ratana; Dat, Truong Cong; Kounnavongsa, Somphone
Migrant beer promoters in Cambodia, Laos, Thailand, and Vietnam were surveyed to determine their experiences in accessing reproductive health care services in the cities of Phnom Penh, Vientiane, Bangkok, and Hanoi. A total of 7 health care institutions were chosen as popular with migrant beer promoters. Staff at these institutions provided information on the institution, and 390 beer promoters were surveyed about their experiences while accessing services. There were discrepancies between findings from the staff interviews and the experiences of the beer promoters. In general, the migrant women were satisfied with the cost, location, friendliness of the health care providers, and knowledge and skills of the providers. They were less positive about confidentiality and waiting times, though many still agreed that these were not an issue. Health care planners and providers should take note of the issues affecting access to reproductive health care services for migrant women when they design and implement services. PMID:22743859
The effect of population growth is not limited to national boundaries. Indeed the inability of people in developing countries to control their own fertility has repercussions on global security and on the balance between population and environment as well a on their health and welfare. All nations need to take steps to slow down rapid population growth now, otherwise we will suffer serious consequences. The different between 2 UN projections of world population equals current world population size. Almost 90% of the increase of the larger projection would occur in developing countries, yet they are the least capable of managing big populations. Further major inequalities in reproductive health between developed and developing countries, as well as between men and women exist. The infant mortality rate in developed regions is around 6 times lower than it is in developing regions, child mortality is 7 times lower, and maternal mortality is 15 times lower. International collaboration to rid the world of these inequalities is need to improve reproductive health. Specifically, political and health leaders should mobilize necessary international and national resources. Even though there is more than US $50,000 million in official development assistance funds available annually, the level of population related funding has decreased to less than 1.1% of these funds for 1993-1994. Developed countries could reduce the debt burden to free funds for population activities and to reverse the flow from the poor countries in the Southern Hemisphere to the rich countries in the Northern Hemisphere. Besides developing countries spend much of their money on the military (e.g. sub-Saharan Africa spends US$ 10,000 million). International cooperation leading to peace would make significantly more money available for the social and health sectors, especially reproductive health care.
Janssens, Sandra; Chokoshvilli, Davit; Binst, Carmen; Mahieu, Inge; Henneman, Lidewij; De Paepe, Anne; Borry, Pascal
Cystic fibrosis (CF) is a life-limiting autosomal recessive disorder affecting ~1 in 2500–4000 Caucasians. As most CF patients have no family history of the disorder, carrier screening for CF has the potential to prospectively identify couples at risk of conceiving an affected child. At-risk couples may consequently choose to act on the provided information and take steps to avoid the birth of a child with CF. Although carrier screening is widely believed to enhance reproductive autonomy of prospective parents, the practice also raises important ethical questions. A written questionnaire was administered to adult patients and parents of children with CF with the aim to explore participants' attitudes toward CF carrier screening and related reproductive issues. The study population was recruited from a CF patient registry in Belgium and comprised 111 participants (64 parents, 47 patients aged 16 or older). We found that more than 80% of all participants were in favor of preconception carrier screening for CF. However, some were concerned over potential negative consequences of population-wide CF carrier screening. Regarding future reproductive intentions, 43% of the participants indicated a desire to have children. Among these, preimplantation genetic diagnosis was found to be the most preferred reproductive option, closely followed by spontaneous pregnancy and prenatal diagnosis. Although the findings of our study suggest that patients and parents of children with CF support a population-based carrier screening program for CF, they also highlight some issues deserving particular attention when implementing such a program. PMID:26220700
Janssens, Sandra; Chokoshvilli, Davit; Binst, Carmen; Mahieu, Inge; Henneman, Lidewij; De Paepe, Anne; Borry, Pascal
Cystic fibrosis (CF) is a life-limiting autosomal recessive disorder affecting ~1 in 2500-4000 Caucasians. As most CF patients have no family history of the disorder, carrier screening for CF has the potential to prospectively identify couples at risk of conceiving an affected child. At-risk couples may consequently choose to act on the provided information and take steps to avoid the birth of a child with CF. Although carrier screening is widely believed to enhance reproductive autonomy of prospective parents, the practice also raises important ethical questions. A written questionnaire was administered to adult patients and parents of children with CF with the aim to explore participants' attitudes toward CF carrier screening and related reproductive issues. The study population was recruited from a CF patient registry in Belgium and comprised 111 participants (64 parents, 47 patients aged 16 or older). We found that more than 80% of all participants were in favor of preconception carrier screening for CF. However, some were concerned over potential negative consequences of population-wide CF carrier screening. Regarding future reproductive intentions, 43% of the participants indicated a desire to have children. Among these, preimplantation genetic diagnosis was found to be the most preferred reproductive option, closely followed by spontaneous pregnancy and prenatal diagnosis. Although the findings of our study suggest that patients and parents of children with CF support a population-based carrier screening program for CF, they also highlight some issues deserving particular attention when implementing such a program.
Keygnaert, Ines; Guieu, Aurore; Ooms, Gorik; Vettenburg, Nicole; Temmerman, Marleen; Roelens, Kristien
The European Union (EU) refers to health as a human right in many internal and external communications, policies and agreements, defending its universality. In parallel, specific health needs of migrants originating from outside the EU have been acknowledged. Yet, their right to health and in particular sexual and reproductive health (SRH) is currently not ensured throughout the EU. This paper reflects on the results of a comprehensive literature review on migrants' SRH in the EU applying the Critical Interpretive Synthesis review method. We highlight the discrepancy between a proclaimed rights-based approach to health and actual obstacles to migrants' attainment of good SRH. Uncertainties on entitlements of diverse migrant groups are fuelled by unclear legal provisions, creating significant barriers to access health systems in general and SRH services in particular. Furthermore, the rare strategies addressing migrants' health fail to address sexual health and are generally limited to perinatal care and HIV screening. Thus, future European public health policy-making should not only strongly encourage its Member States to ensure equal access to health care for migrants as for EU citizens, but also promote migrants' SRH effectively through a holistic and inclusive approach in SRH policies, prevention and care.
Peñas Defago, María Angélica; Morán Faúndes, José Manuel
In Argentina, campaigns for the recognition of sexual and reproductive rights have sparked opposition through litigation in which the dynamics of legal action have come from self-proclaimed "pro-life" NGOs, particularly since 1998, when the conservative NGO Portal de Belén successfully achieved the banning of emergency contraception through the courts. The activities of these groups, acting as a "civil arm" of religion, are focused primarily on obstructing access to legally permissible abortions and bringing about the withdrawal of a number of recognized public policies on sexual and reproductive health, particularly the 2002 National Programme for Sexual Health and Responsible Procreation. This paper analyzes the litigation strategies of these conservative NGOs and how their use of the courts in Argentina has changed over the years. It gives examples of efforts in local courts to block individual young women from accessing legal abortion following rape, despite a ruling by the National Supreme Court of Justice in 2012 that no judicial permission is required. In spite of major advances, the renewed influence of the Catholic hierarchy in the Argentine political scene with the accession of the new Pope poses challenges to the work by feminists and women's movements to extend and consolidate sexual and reproductive rights.
Vadaparampil, Susan T; Hutchins, Nicole M; Quinn, Gwendolyn P
In 2008, approximately 69,200 adolescents and young adults (AYAs) were diagnosed with cancer, second only to heart disease for males in this age group. Despite recent guidelines from professional organizations and clinical research that AYA oncology patients want information about reproductive health topics and physician support for nurses to address these issues with patients, existing research finds few oncology nurses discuss this topic with patients due to barriers such as lack of training. This article describes an innovative eLearning training program, entitled Educating Nurses about Reproductive Issues in Cancer Healthcare. The threefold purpose of this article is to: (1) highlight major reproductive health concerns relevant to cancer patients, (2) describe the current status of reproductive health and oncology communication and the target audience for the training, and (3) present a systematic approach to curriculum development, including the content analysis and design stages as well as the utilization of feedback from a panel of experts. The resulting 10-week curriculum contains a broad-based approach to reproductive health communication aimed at creating individual- and practice-level change.
BACKGROUND Venous thromboembolism (VTE) is a specific reproductive health risk for women. METHODS Searches were performed in Medline and other databases. The selection criteria were high-quality studies and studies relevant to clinical reproductive medicine. Summaries were presented and discussed by the European Society of Human Reproduction and Embryology Workshop Group. RESULTS VTE is a multifactorial disease with a baseline annual incidence around 50 per 100 000 at 25 years and 120 per 100 000 at age 50. Its major complication is pulmonary embolism, causing death in 1-2% of patients. Higher VTE risk is associated with an inherited thrombophilia in men and women. Changes in the coagulation system and in the risk of clinical VTE in women also occur during pregnancy, with the use of reproductive hormones and as a consequence of ovarian stimulation when hyperstimulation syndrome and conception occur together. In pregnancy, the risk of VTE is increased ~5-fold, while the use of combined hormonal contraception (CHC) doubles the risk and this relative risk is higher with the more recent pills containing desogestrel, gestodene and drospirenone when compared with those with levonorgestrel. Similarly, hormone replacement therapy (HRT) increases the VTE risk 2- to 4-fold. There is a synergistic effect between thrombophilia and the various reproductive risks. Prevention of VTE during pregnancy should be offered to women with specific risk factors. In women who are at high risk, CHC and HRT should be avoided. CONCLUSIONS Clinicians managing pregnancy or treating women for infertility or prescribing CHC and HRT should be aware of the increased risks of VTE and the need to take a careful medical history to identify additional co-existing risks, and should be able to diagnose VTE and know how to approach its prevention.
Myer, Landon; Akugizibwe, Paula
The HIV epidemic has changed the face of women's reproductive health across southern Africa. In some circles, there have been calls for restrictions on women's reproductive rights, focusing particularly on the spread of HIV between sexual partners and from mother to child. However, during the past decade, public health attention and resources for the clinical care of HIV-infected individuals living in Africa have led to advances in women's reproductive health services. As many programs have recognized that effective HIV care and treatment services must link to other areas of primary care, key reproductive health services such as those providing contraception and barrier methods are commonly integrated into antiretroviral therapy services. In much of the region, this programmatic focus has helped increase attention on the ground to women's reproductive rights. However, in many settings, policies explicitly supporting the reproductive rights of HIV-infected women have lagged. Important gaps remain both in policy development and in the design, evaluation, and implementation of interventions promoting women's reproductive health and rights at the service delivery level.
Bosse, Jordon D; Nesteby, J Aleah; Randall, Carla E
The health needs of the lesbian, gay, bisexual, and transgender (LGBT) population are traditionally overlooked by the health care community and are rendered invisible by most nursing school curricula. Initial contact with a nurse during a health history and assessment can have an impact on whether the person will feel comfortable disclosing his or her identity, returning for services, or following plans of care. Because the first interaction with a nurse can be critical, the health assessment course is an appropriate place in the curriculum to discuss the needs of the LGBT community. This article includes a discussion of unique health risks to the LGBT population, benefits, and challenges of incorporating these issues into the classroom and recommendations for including the care of this population into a health assessment nursing course. Specific communication techniques are provided that may be helpful during history taking and physical examination with a patient who is LGBT. Guidance regarding physical examination of the transgender patient is also included. These suggestions will be helpful to nurse faculty who teach health assessment, nursing students, educators who design and implement professional development and continuing education for established nurses, preceptors in the clinical setting, and any nurse who is unfamiliar with the needs and concerns specific to the LGBT population.
Sukhareva, L M; Kuindzhi, N N; Iampol'skaia, Iu A
This paper is based on the results of medical examination (single-step and longitudinal) of more than 10,000 schoolgirls and students aged 8-17 and 17-23 years respectively undertaken in Moscow in 1960-2004 and on the archival data (6500 medical cards of primipara women) from maternity hospitals dated to 1981-1990. It was shown that a main feature of growth and development of the female organism in the recent years was gracialization of the girls' stature due to reduced transverse and circumferential body measures including diameter of pelvis. This finding implies a risk of reproductive health impairment with time. Future reproductive potential of schoolgirls is negatively affected by such social factors as excess academic load, psychoemotional stress during the last school year and prior to entering a higher education institution, schoolwork-dominated life style hampering realization of biological needs of the developing organism (in the first place motor activity).
Sills, Eric Scott; Healy, Clifford M
Surrogacy involves one woman (surrogate mother) carrying a child for another person/s (commissioning person/couple), based on a mutual agreement requiring the child to be handed over to the commissioning person/couple following birth. Reasons for seeking surrogacy include situations where a woman has non-functional or absent reproductive organs, or as a remedy for recurrent pregnancy loss. Additionally, surrogacy may find application in any medical context where pregnancy is contraindicated, or where a couple consisting of two males seek to become parents through oocyte donation. Gestational surrogacy is one of the main issues at the forefront of bioethics and the advanced reproductive technologies, representing an important challenge to medical law. This analysis reviews the history of surrogacy and clinical and legal issues pertaining to this branch of reproductive medicine. Interestingly, the Medical Council of Ireland does not acknowledge surrogacy in its current practice guidelines, nor is there specific legislation addressing surrogacy in Ireland at present. We therefore have developed a contract-based model for surrogacy in which, courts in Ireland may consider when confronted with a surrogacy dispute, and formulated a system to resolve any potential dispute arising from a surrogacy arrangement. While the 2005 report by the Commission on Assisted Human Reproduction (CAHR) is an expert opinion guiding the Oireachtas' development of specific legislation governing assisted human reproduction and surrogacy, our report represents independent scholarship on the contractual elements of surrogacy with particular focus on how Irish courts might decide on surrogacy matters in a modern day Ireland. This joint medico-legal collaborative also reviews the contract for services arrangement between the commissioning person/s and the surrogate, and the extent to which the contract may be enforced. PMID:18983640
Finger, William, Comp.; Tipton, Margaret, Comp.
As a sequel to YouthLens No. 1, New Resources Available on Youth Reproductive Health and HIV Prevention (July 2002), this YouthLens summarizes major reports and resources that have appeared since July 2002. The resources are organized by overview reports, reproductive health resources, and HIV/AIDS resources. [YouthLens is an activity of YouthNet,…
Hall, Kelli Stidham; Patton, Elizabeth W.; Zochowski, Melissa K.; Davis, Matthew M.; Dalton, Vanessa K.
Abstract Introduction: The current sociopolitical climate and context of the Affordable Care Act have led some to question the future role of family planning clinics in reproductive health care. We explored where women plan to get their future contraception, pelvic exam/pap smears, and sexually transmitted infection testing, with a focus on the role of family planning clinics. Methods: Data were drawn from a study of United States adults conducted in January 2013 from a national online panel. We focused on English-literate women aged 18–45 years who answered items on intended sources of care (private office/health maintenance organization [HMO], family planning clinic, other, would not get care) for reproductive health services. We used Rao-Scott F tests to compare intended sources across sociodemographic groups, and logistic regression to model odds of intending to use family planning clinics. Probability weights were used to adjust for the complex sampling design. Results: The response rate was 61% (n = 2,182). Of the 723 respondents who met the inclusion criteria, approximately half intended to use private offices/HMOs. Among some subgroups, including less educated (less than high school), lower annual incomes (<$25,000) and uninsured women, the proportion intending to use family planning clinics was higher than the proportion intending to use private office/HMO in unadjusted analyses. Across all service types, unmarried and uninsured status were associated with intention to use family planning clinics in multivariable models. Conclusions: While many women intend to use private offices/HMOs for their reproductive health care, family planning clinics continue to play an important role, particularly for socially disadvantaged women. PMID:26501690
The present study examines how growing socio-economic inequalities in transitional countries that have followed different health policy paths affect women's access to reproductive health care. I conducted surveys in Kazakhstan and Belarus and used logistic regression analyses to determine accessibility to and satisfaction with reproductive health services, reproductive status, and reproductive history based on country of residence. By all measures, access to reproductive health services was most problematic for the low-income women in Kazakhstan but to a significantly lesser extent for economically disadvantaged respondents in Belarus. Differences in education had a significant effect on women's access to reproductive health services in Kazakhstan but were not present in Belarus. Household income was the most powerful predictor of self-perceived health in Kazakhstan, but not in Belarus. The unreformed health-care system in Belarus appears to be more accessible for all women than Kazakhstan's health-care system that underwent significant market-oriented reform.
In addition to food, clothing, and shelter, the hundreds of thousands of refugees fleeing Kosovo need primary health care services, including reproductive health care. The United Nations Population Fund (UNFPA) estimates that of a population of 350,000 refugees in Albania, 35,000 are women in need of prenatal or postnatal care. According to UNFPA, 7 babies were born in 1 refugee camp alone in one 24-hour period, and there are widespread reports of the systematic rape of ethnic Albanian women as they flee. In response, UNFPA announced in early April that it is coordinating the delivery of emergency reproductive health kits to Albanian refugee camps. Each kit contains clean delivery supplies, emergency contraceptive pills (ECP) for women who have been raped, counseling information for post-rape trauma, supplies to treat the complications of unsafe abortion, and condoms, IUDs, and other contraceptive methods. UNFPA expects to send enough supplies to care for the refugees for up to 6 months, with most supplies aimed at providing safe deliveries. The Vatican immediately condemned UNFPA's distribution of ECPs. Whether the US will renew its funding of UNFPA is pending before Congress.
Hogue, C J; Brewster, M A
To further the development and application of exposure markers in field investigations in reproductive epidemiology, we have synthesized recent examinations of the issues surrounding exposure measurements in reproductive epidemiology. The specific goals of this paper are to define exposure biomarkers and explore their potential uses, particularly as screening tools. The tests for glucaric acid, thioethers, mutagenicity, and porphyrin patterns meet the general criteria for useful exposure screens. For certain xenobiotic agents, these tests accurately differentiate exposure levels, as demonstrated in occupational and environmental epidemiologic studies. As urinary screens, they are noninvasive and applicable on a large scale with current laboratory techniques. For short-term exposure, glucaric acid, thioethers, and mutagenicity tests are useful. Porphyrin patterns may measure cumulative effects as well as current exposure levels. The usefulness of these tests in epidemiologic studies of environmental effects on reproductive health has yet to be studied. To do so, the battery must be standardized for pregnant women, and test results must be correlated with measured adverse reproductive outcomes, such as gestational length and birthweight. This correlation is particularly important because maternal exposure rather than fetal exposure is being measured. The extent to which xenobiotic chemicals cross the placental barrier may vary greatly depending on the type of exposures, timing in pregnancy, and maternal detoxification capability. Without better exposure measures, epidemiologic studies of reproductive health probably will not successfully identify xenobiotic fetotoxic agents in the environment. However, with an adequate battery of nonspecific exposure biomarkers, prospective studies of environmental effects on pregnancy outcomes might be possible.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2050070
Fajans, Peter; Simmons, Ruth; Ghiron, Laura
Public sector health systems that provide services to poor and marginalized populations in developing countries face great challenges. Change associated with health sector reform and structural adjustment often leaves these already-strained institutions with fewer resources and insufficient capacity to relieve health burdens. The Strategic Approach to Strengthening Reproductive Health Policies and Programs is a methodological innovation developed by the World Health Organization and its partners to help countries identify and prioritize their reproductive health service needs, test appropriate interventions, and scale up successful innovations to a subnational or national level. The participatory, interdisciplinary, and country-owned process can set in motion much-needed change. We describe key features of this approach, provide illustrations from country experiences, and use insights from the diffusion of innovation literature to explain the approach's dissemination and sustainability.
Hough, Carolyn A
This paper draws on ethnographic fieldwork with Gambian women who have experienced infertility and/or child mortality and who have consequently become kanyalengs. Kanyaleng kafoos are groups of women united by their reproductive difficulties whose bold public performances are designed to "beg God" for fertility and for children who will survive. I situate 'kanyalengs' disrupted childbearing within a framework of stratified reproduction, which reveals the tensions between ongoing demands to meet norms of high fertility, women's heavy burden of reproductive disease and the limits of a reproductive public health agenda narrowly focused on family planning and HIV prevention. To ameliorate these tensions, I call for an expansion of the sexual and reproductive health (SRH) agenda in Gambia to include RTI/STI prevention, diagnosis and management. This expansion reflects the goals set out by the Cairo International Conference on Population and Development for a broader approach to reproductive health, the productive potential of linkages between SRH and HIV prevention efforts, as well as the reproductive objectives of Gambian women and men.
Journal of School Health, 1995
A 1994 conference explored national issues and priorities related to school health nursing, identifying seven critical issues and related actions. Several papers discuss school nurse perspectives, federal agency efforts, issues, and priority actions. An annotated bibliography and information on National Nursing Coalition for School Health are…
Daddona, Mark F.
As more college students face severe mental health issues, peer educators need effective communication skills and knowledge of campus counseling services to properly make referrals while continuing the peer relationship. This chapter presents an overview of current mental health issues in college students. These issues must be understood and…
Jinot, Jennifer; Scott, Cheryl Siegel; Makris, Susan L.; Cooper, Glinda S.; Dzubow, Rebecca C.; Bale, Ambuja S.; Evans, Marina V.; Guyton, Kathryn Z.; Keshava, Nagalakshmi; Lipscomb, John C.; Barone, Stanley; Fox, John F.; Gwinn, Maureen R.; Schaum, John; Caldwell, Jane C.
Background: In support of the Integrated Risk Information System (IRIS), the U.S. Environmental Protection Agency (EPA) completed a toxicological review of trichloroethylene (TCE) in September 2011, which was the result of an effort spanning > 20 years. Objectives: We summarized the key findings and scientific issues regarding the human health effects of TCE in the U.S. EPA’s toxicological review. Methods: In this assessment we synthesized and characterized thousands of epidemiologic, experimental animal, and mechanistic studies, and addressed several key scientific issues through modeling of TCE toxicokinetics, meta-analyses of epidemiologic studies, and analyses of mechanistic data. Discussion: Toxicokinetic modeling aided in characterizing the toxicological role of the complex metabolism and multiple metabolites of TCE. Meta-analyses of the epidemiologic data strongly supported the conclusions that TCE causes kidney cancer in humans and that TCE may also cause liver cancer and non-Hodgkin lymphoma. Mechanistic analyses support a key role for mutagenicity in TCE-induced kidney carcinogenicity. Recent evidence from studies in both humans and experimental animals point to the involvement of TCE exposure in autoimmune disease and hypersensitivity. Recent avian and in vitro mechanistic studies provided biological plausibility that TCE plays a role in developmental cardiac toxicity, the subject of substantial debate due to mixed results from epidemiologic and rodent studies. Conclusions: TCE is carcinogenic to humans by all routes of exposure and poses a potential human health hazard for noncancer toxicity to the central nervous system, kidney, liver, immune system, male reproductive system, and the developing embryo/fetus. PMID:23249866
Donati, S; Grandolfo, M; Spinelli, A; Medda, E
During 1993-94, 5 sex information programs were conducted in various secondary schools in Rome, involving a total of 292 students whose age ranged from 14 to 21 years. The courses were organized in 5 sessions lasting 2 hours each and were held by a specialist in obstetrics and gynecology. Visual teaching materials were presented, followed by discussions. The initiative was evaluated by means of 3 questionnaires: the pretest questionnaire on attitudes and knowledge about reproductive health; the second was administered at the end of the course about recommendations; and the third one verified the modification of the knowledge level 4 months later. 20-50% of the students answered correctly all questions about reproductive health before the course and 70-100% of them at the end of 4 months. 95% of the sample thought that the school should provide information about sexuality and 74% of the students suggested that it should be introduced in the lower grades of secondary schools. The major subjects requested were hygiene and sexually transmitted diseases (75%), sexuality and psychological aspects (68%), and infections (65%). Information about reproductive physiology and contraception among young people was obtained from friends (74%), books and journals (57%), parents (42% for boys and 56% for girls), the school (25%), family counseling (4%), and the family physician (3%). The fertile period of the menstrual cycle was correctly stated by 48% in the pretest sample, 88% after the course, and 93% 4 months later. 87% of the subjects knew that the condom also offers protection against sexually transmitted diseases, but 25% said that it has no expiration date. 23% of the students did not know that abortion is legal in Italy. Family counseling should focus on prevention activities for the school-age population.
Njamen, Dieudonne; Mvondo, Marie Alfrede; Djiogue, Sefirin; Ketcha Wanda, Germain Jean Magloire; Magne Nde, Chantal Beatrice; Vollmer, Günter
Approximately 80 % of the population in Africa use traditional medicinal plants to improve their state of health. The reason of such a wide use of medicinal plants has been mainly attributed to their accessibility and affordability. Expectation of little if any side effects, of a "natural" and therefore safe treatment regimen, as well as traditional beliefs additionally contribute to their popularity. Several of these plants are used by women to relieve problems related to their reproductive health, during or after their reproductive life, during pregnancy, or following parturition. The African pharmacopoeia thus provides plants used for preventing and/or treating gynecological infections, dysmenorrhea, irregular menstruations, oligomenorrhea or protracted menstruation, and infertility. Such plants may then be used as antimicrobians, emmenagogues, or as suppressors of uterine flow. African medicinal plants are also used during pregnancy for prenatal care, against fetal malposition or malpresentation, retained dead fetus, and against threatened abortion. Some others are used as anti-fertilizing drugs for birth control. Such plants may exert various activities, namely, anti-implantation or early abortifacient, anti-zygotic, blastocytotoxic, and anti-ovulatory effects. Some herbs could also act as sexual drive suppressors or as a post-coital contraceptive by reducing the fertility index. A number of these plants have already been subject to scientific investigations and many of their properties have been assessed as estrogenic, oxytocic, or anti-implantation. Taking into account the diversity of the African pharmacopoeia, we are still at an early stage in the phytochemical and pharmacological characterization of these medicinal plants that affect the female reproductive system, in order to determine, through in vitro and in vivo studies, their pharmacological properties and their active principles.
Browner, C H
Despite the existence of 2 government health centers in Mexico's San Francisco township, the use of herbal remedies for the treatment of reproductive health problems and the management of reproduction is almost universal. An ethnographic study conducted in 1980-1981 of 180 women and 126 women investigated use of specific herbal remedies in this highland area. The largest number of reproduction-related medicinal plants used San Francisco are for postpartum recovery. In fact, 80% of the women interviewed reported using only herbal remedies after their last delivery. These remedies are relied on to restore lost blood, heal the birth scar, and stop bleeding. Of the 40% of respondents who reported postpartum hemorrhaging, 70% used herbal remedies. Several of the plants used to treat menorrhagia and hemorrhaging are also used for infertility. The infertility remedies are believed to cleanse the blood and uterus, heal or strengthen the back so the fetus can adhere, help the womb retain the fetus, and cool the blood. Both infertility and miscarriage are attributed to incomplete postpartum recovery. Another large group of medicinal remedies is employed to speed labor or ease labor pains. These remedies are thought to stimulate blood flow or uterine contractions. An additional 15 plants are used to prevent or terminate pregnancy. The mechanism of action in these case is believed to be to both warm the blood to facilitate its flow and irritate the uterus so it will evacuate its contents. Reliance on these remedies derives from Chinantec ethnomedical understandings. Given the persistence of use of herbal remedies in many communities in the Third World, research is needed on their safety and efficacy.
Kouta, Christiana; Tolma, Eleni L
This study examines the knowledge, attitudes and beliefs of Greek-Cypriot adolescents regarding sexuality, sexual and reproductive health in Cyprus. This is the first study in Cyprus that focuses on these issues. During the study, a survey was administered to a random sample of third grade students (N = 697, Mean age = 14 +/- 1 years, 48% males). Descriptive and comparative statistics were primarily used for the data analysis. The results indicated that young Greek-Cypriots have limited knowledge on sexual health issues and that there are gender differences regarding role expectations of sexuality. Thus, in the promotion of healthy sexuality and sexual behaviours among youth, practitioners should include gender and cultural perspectives. Qualitative research is needed to explore in depth how young Greek-Cypriots feel about sexuality and sexual and reproductive health.
Hull, Terence H; Hasmi, Eddy; Widyantoro, Ninuk
Since the ICPD in 1994, the Government of Indonesia has struggled with the challenge of providing sexual and reproductive health education to adolescents. Following an attempt at a family-centred approach, a pilot project was carried out in Central and East Java to train peer educators, coordinated by the National Family Planning Coordinating Board (BKKBN). A total of 80 peer educators (male/female teams) carried out small-group information sessions in ten different districts. Over 1,300 adolescents attended in all. Forty peer counsellors in 20 teams then carried out five outreach sessions each in their communities, attended by nearly 4,000 adults and adolescents. Educators chosen were older in age, knowledge level, authority and communication skills than adolescents, but were well accepted as mentors. Adolescents wanted to know how to deal with sexual relationships and feelings, unwanted pregnancy and STDs. With 42 million Indonesian adolescents needing information, the government cannot produce enough manuals to satisfy demand. New strategies are required to put information in the public domain, e.g. via the media. The approach described in this paper would probably be beyond the staffing and resource capacity of most districts in Indonesia. Nonetheless, it shows that there was great enthusiasm across a variety of communities for efforts to educate young people on protecting their reproductive health.
Lo Yuk-ping, Catherine; Thomas, Nicholas
In the closing decade of the 20th century the myriad challenges posed by infectious disease in a globalized environment began to be re-conceptualized as threats to national and human security. The most widely applied model for identifying and responding to such threats is securitization theory, as proposed by the Copenhagen School. Although its analytical framework is generally accepted, its utility remains contested; especially in non-European and non-state settings. The papers in this special edition have several aims: (1) to analyse ways by which Asian states and international organizations have identified health challenges as security threats, (2) to draw upon the securitization model as a way of understanding the full extent to which these states and international organizations have responded to the health threat, and (3) to identify areas where the theory might be strengthened so as to provide greater analytical clarity in areas of health security. This paper acts as a broad introduction to a set of papers on 'Unhealthy governance' and explores some of the key findings from the subsequent papers.
Prescott, Alexandra S.; Luippold-Roge, Genevieve P.; Gurman, Tilly A.
Objective: Maya women in Guatemala are disproportionately affected by poverty and negative reproductive health outcomes. Although social networks are valued in many Indigenous cultures, few studies have explored whether health education programmes can leverage these networks to improve reproductive health and economic wellbeing. Design: This…
... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration Advisory Committee for Reproductive Health Drugs; Notice of... to the public. Name of Committee: Advisory Committee for Reproductive Health Drugs. General...
Smith, W A
In an overview of the actions undertaken in both the Congress and the Supreme Court related to sexual orientation and abortion, it is noted that the Republican leadership in both houses of Congress have taken up many of the most important spending bills. These include the bill to include abstinence-only-until-marriage funding and the bill to provide evaluation funding. In the context of the US Supreme Court, its decisions have been focused on abortion and sexual orientation. Overall, the activities by both the US Congress and US Supreme Court serve to underscore the importance of the upcoming elections in the US. Further explanation states that the balance of the Court, being so precarious on such important decisions about fundamental rights, serves to highlight the importance of the election. Moreover, the composition of the Congress will play an important role in whether or not the abstinence-only-until-marriage program survives or thrives.
Neogi, Sutapa Bandyopadhyay; Singh, Ranjana; Malhotra, Sumit; Zodpey, Sanjay P; Chauhan, Monika
Defining the human resource needs for providing quality maternal, newborn, and child health services across such a large and diverse population country like India is truly challenging. The effective response to significant challenges and increased requirements of evidence-based effectiveness of the public health projects on maternal and child health is putting pressure on existing program managers to acquire new advanced academic training and information. The data regarding the existing courses on reproductive and child health and related fields in the country were obtained by a predefined search made on the Internet through the Google search engine in December 2011. The collected data were the name and location of the institution offering the respective course, theme, course duration, course structure, eligibility criteria, and mode of learning. In India, around 15 institutes are offering certificate/postgraduate diploma courses on maternal and child health either as a regular program or through distance education program. The admission procedure for each institute is independent of others. The courses vary in terms of duration, eligibility criteria, and fee structure. Conceptualizing an educational initiative in response to national demands for increased workforce capacity to eliminate key medical and nonmedical educational barriers and financial and nonfinancial barriers to advanced academic preparation would enhance the quality of services available in the region.
Sutton, Patrice; Wallinga, David; Perron, Joanne; Gottlieb, Michelle; Sayre, Lucia; Woodruff, Tracey
What food is produced, and how, can have a critical impact on human nutrition and the environment, which in turn are key drivers of healthy human reproduction and development. The US food production system yields a large volume of food that is relatively low in cost for consumers but is often high in calories and low in nutritional value. In this article we examine the evidence that intensive use of pesticides, chemical fertilizers, hormones, antibiotics, and fossil fuel in food production, as well as chemicals in food packaging, are potentially harmful to human reproductive and developmental health. We conclude that policies to advance a healthy food system are necessary to prevent adverse reproductive health effects and avoid associated health costs among current and future generations. These policies include changes to the Farm Bill and the Toxic Substances Control Act, and greater involvement by the health care sector in supporting and sourcing food from urban agriculture programs, farmers' markets, and local food outlets, as well as increasing understanding by clinicians of the links between reproductive health and industrialized food production.
Oliff, Monique; Mayaud, Philippe; Brugha, Ruairí; Semakafu, Ave Maria
Universal access to comprehensive reproductive health services, integrated into a well-functioning health system, remains an unfulfilled objective in many countries. In 2000-2001, in Tanzania, in-depth interviews were conducted with central level stakeholders and focus group discussions held with health management staff in three regional and nine district health offices, to assess progress in the integration of reproductive health services. Respondents at all levels reported stalled integration and lack of synchronisation in the planning and management of key services. This was attributed to fear of loss of power and resources among national level managers, uncertainty as to continuation of donor support and lack of linkages with the Health Sector Reform Secretariat. Among reproductive health programmes, sexually transmitted infection (STI) control alone retained its vertical planning, management and implementation structures. District-level respondents expressed frustration in their efforts to coordinate STI service delivery with other, more integrated programmes. They reported contradictory directives and poor communication channels with higher levels of the Ministry of Health; lack of technical skills at district level to undertake supervision of integrated services; low morale due to low salaries; and lack of district autonomy in decision-making. Integration requires a coherent policy environment. The uncoordinated and conflicting agendas of donors, on whom Tanzania is too heavily reliant, is a major obstacle.
Birn, A E
Over the last decades women have become central to international health efforts, but most international health agencies continue to focus narrowly on the maternal and reproductive aspects of women's health. This article explores the origins of this paradigm as demonstrated in the emergence of women's health in the Rockefeller Foundation's public health programs in Mexico in the 1920s and 1930s. These efforts bore a significant reproductive imprint; women dispensed and received services oriented to maternal and childbearing roles. Women's health and social advocacy movements in Mexico and the United States partially shaped this interest. Even more important, the emphasis on women in the Rockefeller programs proved an expedient approach to the Foundation's underlying goals: promoting bacteriologically based public health to the government, medical personnel, business interests, and peasants; helping legitimize the Mexican state; and transforming Mexico into a good political and commercial neighbor. The article concludes by showing the limits to the maternal and reproductive health model currently advocated by most donor agencies, which continue to skirt--or sidestep--major concerns that are integral to the health of women. Images p400-a p401-a p402-a p403-a PMID:10076494
In 3 recent judgments, the European Court of Human Rights addressed the issue of access to abortion and related reproductive health services. In 2 of the judgments, the Court declared that the state violated women's rights by obstructing access to legal health services, including abortion. In so doing, it referred to the state's failure to implement domestic norms on prenatal testing and conscientious objection, and recognized the relevance of international medical guidelines. This illustrates that domestic and international medical standards can serve as critical guidance to human rights courts. In the third case, the Court showed its unwillingness to declare access to abortion a human right per se, which is troubling from the perspective of women's right to health and dignity. The present article outlines the relevance of these cases for the reproductive health profession and argues that medical professional societies can influence human rights courts by developing and enforcing medical standards, not only for the benefit of abortion rights domestically but also for the advancement of women's human rights worldwide.
This issue of Population Briefs contains articles on researches conducted by the Population Council concerning the delivery of quality of care, contraceptive development, safe abortion, family planning, demography, and medical anthropology. The cover story focuses on a systematic data collection tool called Situation Analysis that helps managers in program evaluation. This tool has a handbook entitled "The Situation Analysis Approach to Assessing Family Planning and Reproductive Health Services" that contains all the information needed to conduct a Situation Analysis study. The second article reports about a new contraceptive method, the two-rod levonorgestrel, which was developed at the Population Council and was recently approved by the US Food and Drug Administration. The third article reports on a medical abortion procedure that was proven to be safe, effective, and acceptable to women in developing countries. Moreover, the fourth article presents initial findings of the Community Health and Family Planning Project conducted in Northern Ghana. The fifth article discusses the paper written by the Population Council demographer, Mark Montgomery entitled "Learning and lags in mortality perceptions". Finally, the sixth article deals with another paper that reports on women's health perceptions and reproductive health in the Middle East.
Olukoya, Adepeju A.
Studied adolescent reproductive health services in two Nigerian states. Found that adolescents use health facilities mostly for general health problems. Only 6.1% (south) and 31.8% (north) of cases involved reproductive health, the gap attributable to maternity cases of northern married women. Reproductive health problems such as abortion and…
McWalter, Kirsty; Gaviglio, Amy
This special issue of the Journal of Genetic Counseling is dedicated to public health genetics and genomics. The seventeen papers featured in this issue span such topics as genetic counselors in public health roles, newborn screening, population screening, ethics, and health beliefs and behaviors. In this introduction to the special issue, we review some history of public health genetics and genomics, present the Centers for Disease Control and Prevention's "10 Essential Public Health Services" with associated genetics specific recommendations and priorities, and briefly overview how each article ties into the world of public health genetics and genomics. We hope this issue encourages genetic counselors to visualize their ever expanding and important roles in public health genetics and genomics, as well as their contributions to improving population health.
Kaddour, Afamia; Hafez, Raghda; Zurayk, Huda
The aim of this study was to elicit definitions of the concept of reproductive health among women in three communities around Beirut, Lebanon, as part of the reproductive health component of a larger Urban Health Study. The communities were characterised by poverty, rural-urban mobility and heterogeneous refugee and migrant populations. A random sample of 1,869 women of reproductive age completed a questionnaire, of whom a sub-sample of 201 women were randomly selected. The women's understanding of good reproductive health included three major themes, which were expressed differently in the three communities. Their understanding included good physical and mental health, and underscored the need for activities promoting health. Their ability to reproduce and raise children, practise family planning and birth spacing, and go through pregnancy and motherhood safely were central to their reproductive duties and their social status. Finally, they saw reproductive health within the context of economic status, good marital relations and strength to cope with their lives. These findings point to the need to situate interventions in the life course of women, their health and that of their husbands and families; the importance of reproduction not only from a health services point of view, but also as regards women's roles and responsibilities within marriage and their families; and taking account of the harsh socio-economic conditions in their communities. A 2005 Reproductive Health Matters. All rights reserved. PMID:16035595
Patel, Preeti; Roberts, Bayard; Guy, Samantha; Lee-Jones, Louise; Conteh, Lesong
Background Reproductive health needs are particularly acute in countries affected by armed conflict. Reliable information on aid investment for reproductive health in these countries is essential for improving the efficiency and effectiveness of aid. The purpose of this study was to analyse official development assistance (ODA) for reproductive health activities in conflict-affected countries from 2003 to 2006. Methods and Findings The Creditor Reporting System and the Financial Tracking System databases were the chosen data sources for the study. ODA disbursement for reproductive health activities to 18 conflict-affected countries was analysed for 2003, 2004, 2005, and 2006. An average of US$20.8 billion in total ODA was disbursed annually to the 18 conflict-affected countries between 2003 and 2006, of which US$509.3 million (2.4%) was allocated to reproductive health. This represents an annual average of US$1.30 disbursed per capita in the 18 sampled countries for reproductive health activities. Non-conflict-affected least-developed countries received 53.3% more ODA for reproductive health activities than conflict-affected least-developed countries, despite the latter generally having greater reproductive health needs. ODA disbursed for HIV/AIDS prevention and treatment increased by 119.4% from 2003 to 2006. The ODA disbursed for other direct reproductive health activities declined by 35.9% over the same period. Conclusions This study provides evidence of inequity in disbursement of reproductive health ODA between conflict-affected countries and non-conflict-affected countries, and between different reproductive health activities. These findings and the study's recommendations seek to support initiatives to make aid financing more responsive to need in the context of armed conflict. PMID:19513098
Bell, Sue Anne; Lori, Jody; Redman, Richard; Seng, Julia
Appropriate and woman-led health care for displaced women is essential to respecting basic human rights. In this paper, we describe the results of an analysis of the association between mental health and reproductive health service use from a sample of Congolese refugee women residing in short and long term camps in Rwanda, with a post-hoc qualitative potion added to expand upon the data-based results. Our findings suggest that structural factors including health policy initiatives affect or even inhibit individual care choices. PMID:26086238
Background With the development of medical technology, many countries around the world have been implementing ethical guidelines and laws regarding Medically Assisted Reproduction (MAR). A physician's reproductive decisions are not solely based on technical criteria but are also influenced by society values. Therefore, the aim of this study was to analyze the factors prioritized by MAR professionals when deciding on whether to accept to perform assisted reproduction and to show any existing cultural differences. Methods Cross-sectional study involving 224 healthcare professionals working with assisted reproduction in Brazil, Italy, Germany and Greece. Instrument used for data collection: a questionnaire, followed by the description of four special MAR cases (a single woman, a lesbian couple, an HIV discordant couple and gender selection) which included case-specific questions regarding the professionals' decision on whether to perform the requested procedure as well as the following factors: socio-demographic variables, moral and legal values as well as the technical aspects which influence decision-making. Results Only the case involving a single woman who wishes to have a child (without the intention of having a partner in the future) demonstrated significant differences. Therefore, the study was driven towards the results of this case specifically. The analyses we performed demonstrated that professionals holding a Master's Degree, those younger in age, female professionals, those having worked for less time in reproduction, those in private clinics and Brazilian health professionals all had a greater tendency to perform the procedure in that case. A multivariate analysis demonstrated that the reasons for the professional's decision to perform the procedure were the woman's right to gestate and the duty of MAR professionals to help her. The professionals who decided not to perform the procedure identified the woman's marital status and the child's right to a
Reviews research on lesbian health risks and behavior, noting methodological difficulties, and focusing on health risks (alcohol, tobacco, and other drug use and sexually transmitted infections) and health care (early detection behavior and barriers to preventive care). Overall, there are behavioral, perceptual, and experiential differences…
Babich, Karen S., Comp.
Five papers cover recent developments in rural mental health nursing. "Rural Mental Health Care: A Survey of the Research" (Karen Babich) chronicles recent interest in understanding the rural population's character and the nature of mental health services needed by and provided to rural America. Lauren Aaronson ("Using Health…
Doherty, William J., Ed.; McCubbin, Hamilton I., Ed.
Discusses research and interventions related to family health care. Topics include health promotion; risk behaviors; vulnerability and illness onset; choosing health care systems; stress; caregiving and coping; family counseling; and family responses to Alzheimer's Disease, pediatric cancer, cystic fibrosis, diabetes, and obesity. (JAC)
McGaha, Glenda S.
Presents health profile of the female offender. Discusses needs in areas of gynecology, breast assessment, and health education and services related to childbearing and parenting. Describes incarcerated health care delivery system and looks to communication and education, nursing personnel, and community resources for potential solutions to…
Pérez, Glòria; Gotsens, Mercè; Palència, Laia; Marí-Dell'Olmo, Marc; Domínguez-Berjón, M Felicitas; Rodríguez-Sanz, Maica; Puig, Vanessa; Bartoll, Xavier; Gandarillas, Ana; Martín, Unai; Bacigalupe, Amaia; Díez, Elia; Ruiz, Miguel; Esnaola, Santiago; Calvo, Montserrat; Sánchez, Pablo; Luque Fernández, Miguel Ángel; Borrell, Carme
The aim is to present the protocol of the two sub-studies on the effect of the economic crisis on mortality and reproductive health and health inequalities in Spain. Substudy 1: describe the evolution of mortality and reproductive health between 1990 and 2013 through a longitudinal ecological study in the Autonomous Communities. This study will identify changes caused by the economic crisis in trends or reproductive health and mortality indicators using panel data (17 Autonomous Communities per study year) and adjusting Poisson models with random effects variance. Substudy 2: analyse inequalities by socioeconomic deprivation in mortality and reproductive health in several areas of Spain. An ecological study analysing trends in the pre-crisis (1999-2003 and 2004-2008) and crisis (2009-2013) periods will be performed. Random effects models Besag York and Mollié will be adjusted to estimate mortality indicators softened in reproductive health and census tracts.
Igras, Susan M.; Macieira, Marjorie; Murphy, Elaine; Lundgren, Rebecka
Very young adolescents (VYAs) between the ages of 10 and 14 represent about half of the 1.2 billion adolescents aged 10–19 in the world today. In lower- and middle-income countries, where most unwanted pregnancies, unsafe abortions, maternal deaths and sexually transmitted infections occur, investment in positive youth development to promote sexual and reproductive health (SRH) is increasing. Most interventions, though, focus on older adolescents, overlooking VYAs. Since early adolescence marks a critical transition between childhood and older adolescence and adulthood, setting the stage for future SRH and gendered attitudes and behaviours, targeted investment in VYAs is imperative to lay foundations for healthy future relationships and positive SRH. This article advocates for such investments and identifies roles that policy-makers, donors, programme designers and researchers and evaluators can play to address the disparity. PMID:24824757
Increasing the numbers of health workers and improving their skills requires that countries confront a number of ethical dilemmas. The ethical considerations in answering five important questions on enabling health workers to deal appropriately with the circumstances in which they must work are described. These include the problems of the standards of training and practice required in countries with differing levels of socioeconomic development and different priority diseases; how a society can be assured that health practitioners are properly trained; how a health system can support its workers; diversion of health workers and training institutions; and the teaching of ethical principles to student health workers. The ethics of setting standards for the skills and care provided by traditional health-care practitioners are also discussed. PMID:15868019
Ford, N J; Siregar, K N
The new politics of family planning in the 1990s has involved the articulation of a comprehensive concept of sexual and reproductive health (SRH). Following the ratification of the SRH concept and goals at recent international conferences, one major issue is how governments translate the broad statements into operational policies and programs. The authors consider the ways in which the process is occurring in Indonesia, defining SRH, and reviewing the levels of its attainment in 8 of its components in Indonesia. The policy process in Indonesia is explored with regard to pre-existing reassessments, setting important priorities and moralistic and pragmatic policy orientations. The following SRH components are discussed: family planning, infertility, maternal and child health, HIV/AIDS, sexually transmitted diseases, adolescents' needs, sexual health, and gender issues. In terms of SRH, Indonesia has achieved considerable success in addressing family planning and infant and child mortality, limited success in addressing maternal mortality and HIV/AIDS, and very little progress in addressing STDs, adolescent needs, and positive sexuality. There are few data on gender issues.
This publication identifies, discusses, and lists areas for further research for five ethical issues related to health services: 1) the right to health care; 2) death and euthanasia; 3) human experimentation; 4) genetic engineering; and, 5) abortion. Following a discussion of each issue is a selected annotated bibliography covering the years 1967…
Katz, Arthur J., Ed.
Articles by social work educators on some of the critical issues in community mental health are presented. Examined are some conceptual and program developments related to coordination, continuity of care, and the use of teams in planning and service delivery for community mental health (Lawrence K. Berg). The issue of civil commitment to and…
Cordes, D. H.; And Others
The University of Arizona Medical School focuses on occupational health issues in a five-week interdisciplinary summer institute for medical students and in a portion of a required course on clinical medicine. Students learn about occupational health issues through lectures, seminars, and visits to local workplace settings. (DB)
Beginning on August 30, representatives from more than 180 UN member states and women's rights advocates from every continent convened in the People s Republic of China for the much-anticipated UN Fourth World Conference on Women (FWCW) in Beijing and the Nongovernmental Organization (NGO) Forum in Huairou. The Forum, which ran through September 8, boasted 20,000 attendees. Participants conducted numerous workshops, staged multiple demonstrations, and strategized about how to lobby governments negotiating the FWCW Platform for Action. That document focuses on eliminating discrimination against women in twelve key issue areas: poverty, education, health, violence against women, armed conflict, economic structures, women in decision making, policy and program planning, human rights, media and communications, environment, and the girl child. During debate over the section, issues such as sexual rights, sexual health abortion and adolescents' rights to reproductive health information sparked the greatest opposition from conservative forces. Government delegates approved the health section in its entirety by September 13, whereby they confirmed the commitments made at the International Conference on Population and Development (ICPD) in Cairo in September 1994. Paragraph 97 states that the human rights of women include their right to have control over their sexuality, including sexual and reproductive health, free of discrimination and violence and also calls for equal relationships between women and men in sexual relations and reproduction. Paragraph 107 calls on governments to review laws containing punitive measures against women who have undergone illegal abortions. Finally, Paragraph 108 (e) takes into account the rights of the child to access to information, privacy, confidentiality, respect and informed consent on matters concerning sexuality and reproduction. FWCW was scheduled to conclude on September 15. Governmental delegates had not yet finished negotiating
Chavkin, Wendy; And Others
The reproductive health of first generation, non-Hispanic Caribbean immigrants in New York were studied. Descriptive profiles of risk factors and reproductive outcomes were developed and compared to those of other populations. These data provide a foundation for planning and implementing health programs to meet the needs of this immigrant group.…
Reproductive health education for early childhood it has been the time to teach, because the demand of the changing times and will affect the child's life when he/she is a teenager. During this time, the reproductive health education, which is in it there is sex education, considered taboo among some communities. They argue that the reproductive…
Lindley, Lisa L.; Reininger, Belinda M.; Saunders, Ruth P.
Surveyed South Carolina registered voters regarding level of support for school-based reproductive health services. Most voters supported providing contraceptive information, counseling, and referrals to students. They were less supportive of providing students with more direct and possibly invasive reproductive health services at school. Few…
Roos, Noralou P.; O'Grady, Kathleen; Singer, Sharon Manson; Turczak, Shannon; Tapp, Camilla
The media shape consumer expectations and interpretations of health interventions, influencing how people think about their need for care and the sustainability of the system. EvidenceNetwork.ca is a non-partisan, web-based project funded by the Canadian Institutes of Health Research and the Manitoba Health Research Council to make the latest evidence on controversial health policy issues available to the media. This website links journalists with health policy experts. We publish opinion pieces on current health policy issues in both French and English. We track who follows and uses the EvidenceNetwork.ca website and monitor the impact of our efforts. PMID:23968614
Parekh, Jenita; Tunçalp, Özge; Turke, Shani; Blum, Robert William
We systematically reviewed peer-reviewed and gray literature on comprehensive adolescent health (CAH) programs (1998–2013), including sexual and reproductive health services. We screened 36 119 records and extracted articles using predefined criteria. We synthesized data into descriptive characteristics and assessed quality by evidence level. We extracted data on 46 programs, of which 19 were defined as comprehensive. Ten met all inclusion criteria. Most were US based; others were implemented in Egypt, Ethiopia, and Mexico. Three programs displayed rigorous evidence; 5 had strong and 2 had modest evidence. Those with rigorous or strong evidence directly or indirectly influenced adolescent sexual and reproductive health. The long-term impact of many CAH programs cannot be proven because of insufficient evaluations. Evaluation approaches that take into account the complex operating conditions of many programs are needed to better understand mechanisms behind program effects. PMID:25320876
Carretero Ares, José Luis; Cueva Oliver, Begoña; Vidal Martínez, Asunción; Rigo Martínez, María Vicenta; Lobato Cañón, José Rafael
Informal economy must be differentiated from concepts such as informal employment and the informal sector, each with its own characteristics. There are several types of informal workers that are grouped into several categories according to their work. The families of these workers are grouped into vulnerable job, which is also not beneficial for health coverage. Informal working conditions mean great morbidity resulting in economic losses and a large number of quality-adjusted life year, especially among young populations and women. Health policies are needed to reduce socio-economic inequalities, improve the training of health professionals and the accessibility of health services to these workers.
Waldman, Linda; Stevens, Marion
Information and Communications Technology (ICT) offers enormous opportunity and innovation to improve public health and health systems.This paper explores the intersections between mHealth and sexual and reproductive health and rights in both policy and practice. It is a qualitative study, informed by policy review and key informant interviews. Three case studies provide evidence of what is happening on the ground in relation to ICTs and reproductive health and rights. We argue that in terms of policy, there is little overlap between health rights and communication technology. In the area of practice, however, significant interventions address aspects of reproductive health. At present, the extent to which mHealth addresses the full range of reproductive justice and sexual and reproductive health and rights is limited, particularly in terms of government initiatives. The paper argues that mHealth projects tend to avoid contentious aspects of sexual health, while addressing favourable topics such as pregnancy and motherhood. The ways in which information is framed in mHealth mirrors current gaps within sexual and reproductive health and rights, where a limited and conservative lens predominates, and which may result in narrow programming and implementation of services.
Lewis, John; Dempsey, Joanne R.
An article on American health care which focuses on health care costs and benefits is combined with a lesson plan on health care issues to enable students to consider both issues of cost effectiveness and morality in decisions about the allocation of health care. The article covers the history of interest in health care, the reasons for the…
Bosmans, Marleen; Gonzalez, Fernando; Brems, Eva; Temmerman, Marleen
In Colombia, national policies and laws on the protection of vulnerable populations pay specific attention to the sexual and reproductive health needs and rights of internally displaced adolescents. This paper describes how a United Nations Population Fund (UNFPA)-supported programme (September 2000-August 2004) on the sexual and reproductive health of internally displaced adolescents contributed to restoring their dignity as a precursor to promoting their sexual and reproductive health rights. Different forms of the arts were used as basic techniques to discover their body and to provide sexual and reproductive health information and education. The arts were found to play a key role in restoring their dignity. Although dignity appeared to be a determinant of greater awareness of rights, it did not lead to increased empowerment with regard to rights. The availability of and access to sexual and reproductive health services remains a problem and displaced populations continue to have little or no power to hold their authorities accountable.
This chapter summarizes the key health information on ubiquitous outdoor air pollutants that can cause adverse health effects at current or historical ambient levels in the United States. Of the thousands of air pollutants, very few meet this definition. The Clean Air Act (CA...
Aguirre-Molina, Marilyn, Ed.; Molina, Carlos W., Ed.; Zambrana, Ruth Enid, Ed.
This collection of papers includes 6 parts. Part 1, "Latino Populations in the United States," includes: (1) "Latino Health Policy: Beyond Demographic Determinism" (Angelo Falcon, Marilyn Aguirre-Molina, and Carlos W. Molina); (2) "Latino Health Status" (Olivia Carter-Pokras and Ruth Enid Zambrana); and (3)…
address the best method of funding for veterans’ health care, while continuing to focus on ensuring a “seamless transition” process for servicemembers...Health Enrollment Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Table 2. VA Spending and Number of OIF and OEF...Home for Disabled Volunteer Soldiers, administered various benefits for the nation’s veterans. 9 For details on the appeals process , see CRS Report
Stroud, Joanne; Rollins, Kathy
Many adolescents need basic health care and other services that address risky behaviors such as sexual activity, violence, alcohol and other drug abuse, and the consequences of those behaviors. This publication summarizes approximately 200 child health-related laws and resolutions passed in the 50 states, Puerto Rico, American Samoa, and the U.S.…
Coughlin, Steven S.; Lewis, Sharon R.; Smith, Selina A.
The use of inmates in research in the U.S. was restricted by the recommendations of the National Commission and by federal regulations and guidelines that followed. By the 1980s, many health care officials became concerned about the exclusion of inmates from experimental treatments for human immunodeficiency virus infection (HIV). These developments in ethics occurred in the context of racial/ethnic disparities in health. In this article, ethical considerations in clinical and public health research on HIV in prison and jail settings are considered. Ethical considerations in mental health research are summarized as well as issues pertaining to research involving female inmates. Issues related to oversight of research involving incarcerated people are considered along with the ethics of public health research. The ethics of research involving incarcerated people extends beyond traditional issues in human subjects ethics to include issues within the domains of bioethics and public health ethics. PMID:27133509
Coughlin, Steven S; Lewis, Sharon R; Smith, Selina A
The use of inmates in research in the U.S. was restricted by the recommendations of the National Commission and by federal regulations and guidelines that followed. By the 1980s, many health care officials became concerned about the exclusion of inmates from experimental treatments for human immunodeficiency virus infection (HIV). These developments in ethics occurred in the context of racial/ethnic disparities in health. In this article, ethical considerations in clinical and public health research on HIV in prison and jail settings are considered. Ethical considerations in mental health research are summarized as well as issues pertaining to research involving female inmates. Issues related to oversight of research involving incarcerated people are considered along with the ethics of public health research. The ethics of research involving incarcerated people extends beyond traditional issues in human subjects ethics to include issues within the domains of bioethics and public health ethics.
Cornett, Becky Sutherland
Our health-care system is burdened with high costs, health-care disparities, overtreatment, undertreatment, high error rates, and fraud and abuse. At the same time, the United States has achieved spectacular medical advances using the latest technology. As a result, health-care quality measurement, publicly reported patient safety and quality indicators, and evaluation of patients' experience of care are watchwords of a new era of accountability for health-care professionals and organizations. The health-care industry is subject to increasing regulation, private sector challenges, and public demand to make significant improvements in all three components of the quality triad: structure, process, and outcome. This article examines regulatory initiatives and industry trends pertaining to patient safety and quality measurement and concludes with specific suggestions for the professions of speech-language pathology and audiology.
Solomonides, Anthony E; Mackey, Tim Ken
The problems of poor or biased information and of misleading health and well-being advice on the Internet have been extensively documented. The recent decision by the Internet Corporation for Assigned Names and Numbers to authorize a large number of new generic, top-level domains, including some with a clear connection to health or healthcare, presents an opportunity to bring some order to this chaotic situation. In the case of the most general of these domains, ".health," experts advance a compelling argument in favor of some degree of content oversight and control. On the opposing side, advocates for an unrestricted and open Internet counter that this taken-for-granted principle is too valuable to be compromised, and that, once lost, it may never be recovered. We advance and provide evidence for a proposal to bridge the credibility gap in online health information by providing provenance information for websites in the .health domain.
Verret, Catherine; Jutand, Mathe-Aline; De Vigan, Catherine; Bégassat, Marion; Bensefa-Colas, Lynda; Brochard, Patrick; Salamon, Roger
Background Since 1993, many studies on the health of Persian Gulf War veterans (PGWVs) have been undertaken. Some authors have concluded that an association exists between Gulf War service and reported infertility or miscarriage, but that effects on PGWV's children were limited. The present study's objective was to describe the reproductive outcome and health of offspring of French Gulf War veterans. Methods The French Study on the Persian Gulf War (PGW) and its Health Consequences is an exhaustive cross-sectional study on all French PGWVs conducted from 2002 to 2004. Data were collected by postal self-administered questionnaire. A case-control study nested in this cohort was conducted to evaluate the link between PGW-related exposures and fathering a child with a birth defect. Results In the present study, 9% of the 5,666 Gulf veterans who participated reported fertility disorders, and 12% of male veterans reported at least one miscarriage among their partners after the PGW. Overall, 4.2% of fathers reported at least one child with a birth defect conceived after the mission. No PGW-related exposure was associated with any birth defect in children fathered after the PGW mission. Concerning the reported health of children born after the PGW, 1.0% of children presented a pre-term delivery and 2.7% a birth defect. The main birth defects reported were musculoskeletal malformations (0.5%) and urinary system malformations (0.3%). Birth defect incidence in PGWV children conceived after the mission was similar to birth defect incidence described by the Paris Registry of Congenital Malformations, except for Down syndrome (PGWV children incidence was lower than Registry incidence). Conclusion This study did not highlight a high frequency of fertility disorders or miscarriage among French PGW veterans. We found no evidence for a link between paternal exposure during the Gulf War and increased risk of birth defects among French PGWV children. PMID:18442369
Dunn, Kate M; Das, Susmita; Das, Rumeli
Background A paucity of information about male reproductive health and a perceived interest in involvement among local men provided the impetus for carrying out a village based male reproductive health camp. The aim was to investigate men's willingness to participate in such camps, and to describe reproductive health problems in men. Methods Structured interviews were carried out with 120 men attending a reproductive health check-up in a village in rural West Bengal, India. General information, details of family planning methods used and data on reproductive health complaints were collected. Clinical examinations were also carried out. Socio-demographic characteristics were compared for men with and without reproductive health and urinary complaints. Results Three quarters of the married men were using contraception, but the majority stated that their wives were responsible for it. The most common reproductive health complaint was urinary problems; 28% had burning on urination, and 22% reported frequent and/or difficult urination. There were few social or demographic differences between men with and without problems. Seventeen percent of the men had clinically diagnosed reproductive health problems, the most common being urethral discharge. None of the men with diagnosed problems were using condoms. Conclusions This study highlights the interest of men in their reproductive health, but also highlights the high proportion of men with problems. In addition, a number of men with clinically diagnosed problems had not reported them in the interviews, illustrating either the reticence to report or the lack of knowledge about symptoms of reproductive health problems. Recommendations for future programmes and research in this field are given. PMID:15555073
Grajewski, Barbara; Coble, Joseph B; Frazier, Linda M; McDiarmid, Melissa A
Assuring reproductive health in the workplace challenges researchers, occupational safety and health practitioners, and clinicians. Most chemicals in the workplace have not been evaluated for reproductive toxicity. Although occupational exposure limits are established to protect 'nearly all' workers, there is little research that characterizes reproductive hazards. For researchers, improvements in epidemiologic design and exposure assessment methods are needed to conduct adequate reproductive studies. Occupational safety and health programs' qualitative and quantitative evaluations of the workplace for reproductive hazards may differ from standardized approaches used for other occupational hazards in that estimates of exposure intensity must be considered in the context of the time-dependent windows of reproductive susceptibility. Clinicians and counselors should place the risk estimate into context by emphasizing the limitations of the available knowledge and the qualitative nature of the exposure estimates, as well as what is known about other non-occupational risk factors for adverse outcomes. This will allow informed decision-making about the need for added protections or alternative duty assignment when a hazard cannot be eliminated. These policies should preserve a worker's income, benefits, and seniority. Applying hazard control technologies and hazard communication training can minimize a worker's risk. Chemical reproductive hazard training is required for workers by the Occupational Safety and Health Administration's Hazard Communication Standard. The National Institute for Occupational Safety and Health (NIOSH) has formed a National Occupational Research Agenda Team to promote communication and partnering among reproductive toxicologists, clinicians and epidemiologists, to improve reproductive hazard exposure assessment and management, and to encourage needed research.
Snow, Rachel C.; Laski, Laura; Mutumba, Massy
We examine progress towards the 1994 International Conference on Population and Development (ICPD) commitment to provide universal access to sexual and reproductive health (SRH) services by 2014, with an emphasis on changes for those living in poor and emerging economies. Accomplishments include a 45% decline in the maternal mortality ratio (MMR) between 1990 and 2013; 11.5% decline in global unmet need for modern contraception; ~21% increase in skilled birth attendance; and declines in both the case fatality rate and rate of abortion. Yet aggregate gains mask stark inequalities, with low coverage of services for the poorest women. Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 80 developing countries highlight persistent disparities in skilled birth attendance by household wealth: in 70 of 80 countries (88%), ≥80% of women in the highest quintile were attended by a skilled provider at last birth; in only 23 of the same countries (29%) was this the case for women in the lowest wealth quintile. While there have been notable declines in HIV incidence and prevalence, women affected by HIV are too often bereft of other SRH services, including family planning. Achieving universal access to SRH will require substantially greater investment in comprehensive and integrated services that reach the poor. PMID:25555027
Deeb-Sossa, Natalia; Díaz Olavarrieta, Claudia; Juárez-Ramírez, Clara; García, Sandra G; Villalobos, Aremis
This study focuses on the experience of Mexican women migrants in California, USA, with the use of formal health services for sexual and reproductive health issues. The authors used a qualitative interpretative approach with life histories, interviewing eight female users of healthcare services in California and seven key informants in Mexico and California. There were three main types of barriers to healthcare: immigration status, language, and gender. Participants reported long waiting times, discriminatory attitudes, and high cost of services. A combination of formal and informal healthcare services was common. The assessment of quality of care was closely related to undocumented immigration status. Social support networks are crucial to help solve healthcare issues. Quality of care should take intercultural health issues into account.
Lantieri, Linda; And Others
This document is designed to provide students with an opportunity to share feelings and clarify their own values given the facts about nuclear technology. Using this short curriculum, students should be able to: (1) explore their associations with nuclear issues; (2) analyze guidelines for conflict resolution in personal situations; (3) analyze…
Background The mass media have excellent potential to promote good sexual and reproductive health outcomes, but around the world, media often fail to prioritize sexual and reproductive health and rights issues or report them in an accurate manner. In sub-Saharan Africa media coverage of reproductive health issues is poor due to the weak capacity and motivation for reporting these issues by media practitioners. This paper describes the experiences of the African Population and Health Research Center and its partners in cultivating the interest and building the capacity of the media in evidence-based reporting of reproductive health issues in sub-Saharan Africa. Methods The paper utilizes a case study approach based primarily on the personal experiences and reflections of the authors (who played a central role in developing and implementing the Center’s communication and policy engagement strategies), a survey that the Center carried out with science journalists in Kenya, and literature review. Results The African Population and Health Research Center’s media strategy evolved over the years, moving beyond conventional ways of communicating research through the media via news releases and newspaper stories, to varying approaches that sought to inspire and build the capacity of journalists to do evidence-based reporting of reproductive health issues. Specifically, the approach included 1) enhancing journalists’ interest in and motivation for reporting on reproductive health issues through training and competitive grants for outstanding reporting ; 2) building the capacity of journalists to report reproductive health research and the capacity of reproductive health researchers to communicate their research to media through training for both parties and providing technical assistance to journalists in obtaining and interpreting evidence; and 3) establishing and maintaining trust and mutual relationships between journalists and researchers through regular informal
Cohen, Beth E.; Maguen, Shira; Bertenthal, Daniel; Shi, Ying; Jacoby, Vanessa; Seal, Karen H.
Background An increasing number of women serve in the military and are exposed to trauma during service that can lead to mental health problems. Understanding how these mental health problems affect reproductive and physical health outcomes will inform interventions to improve care for women veterans. Methods We analyzed national VA data from women Iraq and Afghanistan veterans who were new users of VA healthcare from 10/7/2001 through 12/31/2010 (N=71,504). We used ICD-9 codes to categorize veterans into 5 groups by mental health diagnoses (MH Dx), those with: no MH Dx, PTSD, depression, comorbid PTSD and depression, and MH Dx other than PTSD and depression. We determined the association between mental health category and reproductive and other physical health outcomes defined by ICD-9 codes. Categories included sexually transmitted infections, other infections (e.g. urinary tract infections), pain-related conditions (e.g. dysmenorrhea and dsypareunia), and other conditions (e.g. polycystic ovarian syndrome, infertility, sexual dysfunction). Models were adjusted for sociodemographics and military service factors. Results 31,481 (44%) received at least one mental health diagnosis. Women veterans with any mental health diagnosis had significantly higher prevalences of nearly all categories of reproductive and physical disease diagnoses (p <.0001 for adjusted prevalences). There was a trend of increasing prevalence of disease outcomes in women with PTSD, depression, and comorbid PTSD and depression (p for trend <.0001 for all outcomes). Conclusions Iraq and Afghanistan women veterans with mental health diagnoses had significantly greater prevalences of several important reproductive and physical health diagnoses. These results provide support for VA initiatives to address mental and physical health concerns and improve comprehensive care for women veterans. PMID:22944901
Negative effects include allergic reactions to their bites, secondary infections from the bite reaction such as impetigo, and mental health impacts on people living in infested homes such as anxiety and insomnia.
... priorities are changing, and Fogarty is helping to train medical researchers around the globe to meet new ... discovery; the remaining two-thirds provide support to train research scientists in global health. Dr. Roger Glass, ...
Mchome, Zaina; Richards, Esther; Nnko, Soori; Dusabe, John; Mapella, Elizabeth; Obasi, Angela
Unwelcoming behaviours and judgemental attitudes have long been recognised as a barrier to young people's access to reproductive health services. Over the last decade youth friendly reproductive health services have been promoted and implemented world-wide. However, long term evidence of the impact of these programmes is lacking. We report the results of a large mystery client evaluation of adolescent sexual and reproductive health services in Tanzania, a country that has had a long established youth friendly policy. Forty-eight visits made to thirty-three health facilities were conducted by twelve young people (six in each region) trained to perform three different scripted scenarios (i.e., condom request, information on sexually transmitted infections and family planning). The study revealed barriers in relation to poor signage and reception for services. In addition health workers demonstrated paternalistic attitudes as well as lack of knowledge about adolescent sexual and reproductive health services. In some cases, health workers discouraged young people from using services such as condoms and family planning methods. Lack of confidentiality and privacy were also noted to be common challenges for the young people involved. Intervention strategies that focus on changing health workers' mind-set in relation to adolescent sexual and reproductive health are crucial for ensuring quality provision of sexual and reproductive health services to young people. The study identified the importance of reception or signs at the health units, as this can facilitate young people's efforts in seeking sexual and reproductive health services. Likewise, improvement of health workers knowledge of existing policy and practice on sexual and reproductive health services and youth friendly services is much needed.
Protestantism is not a centralized religion. It is composed by many independent Churches having different moral and ethical standards. This review concentrates on the ethical principles prevalent in most modern European Reformed Churches. It does not intend to discuss the ethical principles of many other Protestant Churches present mainly in the USA. The common foundations of Protestant theology are the "five sola ("Sola scriptura", Sola fide", "Sola gratia", Solus Christus or Solo Christo", "Soli deo gloria"). In opposition to the Catholic Church, no intermediary is needed between the Bible and the believer. As a consequence, Protestant Churches have no Magisterium, such as the Catholic Church. Therefore Protestant Churches cannot declare a certain position to be the "official position". Each Christian is personally responsible for all his acts, including his ethical behaviour. There is no complete unanimity among all Protestants on ethics or on any other issue. Human dignity, personal rights and self-determination have to be respected in each ethical consideration. The supersession of the Old Mosaic Covenant (including traditional Jewish law or Halakhah, maintained in Catholicism) by the New Covenant and by Christian Theology has an important impact on Protestant ethics in reproductive medicine. In the New Covenant, the Protestants Churches did not maintain the mandatory obligation from the old Mosaic Covenant to be fruitful and to multiply: there is no divine obligation by God to procreate. As a consequence, contraception is not a sin and not unethical. The status of the embryo is the key for the ethical consideration of all methods used in reproductive medicine. Most representatives of modern Protestant theology and bioethics defend the opinion that the embryo is not an independent human being as is the newborn child. For most Protestant bio-ethicists, as long as an embryo has no nervous system, no organs and no pain receptors, it cannot be seen as a human
Erdman, Joanna N; Cook, Rebecca J
The worldwide burden of reproductive and sexual ill-health falls disproportionately on women belonging to vulnerable and disadvantaged groups. Women's rights to reproductive and sexual health, as protected under national constitutions as well as regional and international human rights treaties, require that health systems account for the distinctive needs and circumstances both of and among women. The purpose of this article is to investigate what we can do as advocates to ensure that the reproductive and sexual health rights of all women are respected, protected, and enforced, both internationally and in Canada.
Kiker, B. F.
Introduces a special issue devoted to education-health linkages. The scope of coverage is quite broad. Papers treat education's connections with specific health-related behaviors, full-time employees' health insurance coverage, medical care/lifestyle choices, nurses' wage profiles, low birthweight children's capabilities, smoking decisions,…
Wyatt, Tammy; Oswalt, Sara B.
Background: Stress and other mental health issues can negatively impact the health and academic performance of college students. Purpose: Examine relationships among stress, mental health, and academic classification in a national sample of college students. Methods: Analyses utilized secondary data from 27 387 college students responding to the…
DeLoach, Kendra P.; Dvorsky, Melissa; Miller, Elaine; Paget, Michael
Students with emotional and behavioral challenges are significantly impacted by mental health issues. Teachers and other school staff need mental health knowledge to work more effectively with these students. Collaboration with mental health professionals and sharing of information is essential. [For complete volume, see ED539318.
Adinma, J I B; Adinma, E D
The link between reproductive health, sexual and reproductive right, and development was highlighted at the International Conference on Population and Development held in Egypt. Developmental disparities are related to socio-economic differences which have led to the identification of distinct socio-economic classifications of nations. Human development represents the socioeconomic standing of any nation, in addition to literacy status and life expectancy. Africa accounts for 25% of the world's landmass but remains the world's poorest continent. Nigeria, the most populous country in Africa, has policies and programmes geared towards the improvement of its socio-economic standing and overal development, with little positive result. Reproductive health is a panacea towards reversing the stalled socio-economic growth of Nigeria as evident from the linkage between reproductive health and development, highlighted in Millennium Development Goals 3, 4, 5 and 6. Fast tracking Nigeria's development requires implementation of reproductive health policies and programmes targeted on women and children.
The recent US Supreme Court decision in Planned Parenthood v Casey, by changing the legal standard by which restrictions on abortion are evaluated, will have a profound effect on access to reproductive health care in the United States. This article reviews the Pennsylvania antiabortion restrictions at issue in Casey and discusses the ways in which the new constitutional standard fundamentally weakens the legal protections previously afforded women and physicians in the 1973 case, Roe v Wade. While the majority opinion reaffirmed a woman's right to choose an abortion, the opinion opens the door to a multitude of new restrictive abortion laws, which diminish, and in some cases completely block, a woman's ability to exercise that right. The effect of weakened legal protection will fall most heavily on young, poor, minority, and rural women, who will be unable to overcome obstacles imposed by mandatory waiting periods, biased counseling, and parental notification requirements. The restrictions are also likely to exacerbate the shortage of physicians providing abortion services by making the procedure more costly and the providers' jobs more dangerous. Finally, the medical community can help to ensure women access to comprehensive and competent reproductive health care.
Cronley, Courtney; Hohn, Kris; Nahar, Shamsun
Women experiencing homelessness report higher rates of reproductive health-related traumas, including unplanned pregnancy, miscarriage, and abortion than their non-homeless peers. Using phenomenological hermeneutic methods, we sought to understand the reproductive health histories of women currently experiencing homelessness (N = 20, 25-61 years old, Mage = 38.33, SDage = 9.33) analyzing data collected between June 2014 and July 2015 in north central Texas. Three key themes highlight the essence of the women's experiences: (1) unexpected pregnancy-pregnancy just happened, (2) loss of reproductive health rights-I was broken, and (3) resilience-giving back and looking forward to good things. Many of the women became mothers through unexpected pregnancies, and overnight found that their lives were transformed irrevocably. Often unexpected pregnancy was the result or cause of a lack of ownership over their reproductive health and led to prolonged health-related traumas. Over time, though, many of the women whom we interviewed re-expressed resilience through social support, housing assistance, and a sense of giving back to society. Results indicate that reproductive health care providers require training to identify the relationship among unexpected pregnancy, reproductive health-related traumas, and housing insecurity. Providers can help preserve women's reproductive health rights through education and empowerment.
Caulfield, T A; Robertson, G B
There is a growing body of literature and commentary analyzing the ethical and public policy concerns associated with xenotransplantation. While this technology holds great promise to provide an almost limitless supply of organs for transplantation, there remains grave concern about possible public health ramifications. As a result, it has been recommended that patients who undergo xenotransplantations will need to agree, inter alia, to a lifetime of close health monitoring, participation in an international database and autopsy upon death. It has been suggested that this agreement would transform the nature of informed consent into a "binding contract." Though such draconian measures are understandable given the magnitude of the risks involved, would existing common law and legislation allow their implementation? This paper analyzes relevant Canadian consent and public health law in the context of the xenotransplantation. Canada is a country with a particularly rich body of informed consent jurisprudence--jurisprudence firmly rooted (rightly or not) in the ethical principle of autonomy. In this climate, many of the suggested monitoring strategies would find little support from Canadian law. Before xenotransplantations proceed, policy makers must be sensitive to the legal barriers which exist to the implementation [of] effective public health measures. Effective surveillance programs will require novel approaches to consent and the enactment of specific public health laws.
Various reports have shown that internal and external exposure levels of local residents after the accident at Fukushima Daiichi nuclear power plant were very low. However, there are serious postdisaster health effects in the form of increased prevalence of diabetes and other chronic conditions. Stress, changes in the social environment and in living arrangements, and disruption in healthcare support provided by a network of people have resulted in increasing the cost of care and changing patients' behaviour, such as delay in visiting a hospital. In addition to radiation protection, it is necessary, when looking after the health of Fukushima residents, to focus on human networking, social infrastructure, and protection of culture and history that are intangible, and not to overlook their roles in health.
Lohr, W David; Jones, V Faye
Children in foster care have exceptional needs due to their histories of abuse, neglect, and increased exposure to violence. The rates of psychiatric symptoms and disorders, such as attention-deficit/hyperactivity disorder, posttraumatic stress disorder, and reactive attachment disorder, are much higher in children in foster care; furthermore, the rate of these children receiving psychotropic medications is 3 times that of children who are not in foster care. Pediatricians, in their role of providing a medical home, play a central role in safeguarding the physical and mental health of these children. By taking a trauma-informed approach to understanding the unique needs and gaps in their health care, pediatricians can improve the mental health and maximize outcome for children in foster care. [Pediatr Ann. 2016;45(10):e342-e348.].
Hertzber, V.S.; Lemasters, G.K.; Hansen, K. ); Zenick, H.M. )
Establishing the relationship between a given chemical exposure and human reproductive health risk is complicated by exposures or other concomitant factors that may vary from pregnancy to pregnancy. Moreover, when exposures are to complex mixtures of chemicals, varying with time in number of components, doses of individual components, and constancy of exposure, the picture becomes even more complicated. A pilot study of risk of adverse reproductive outcomes among male wastewater treatment workers and their wives is described here. The wives of 231 workers were interviewed to evaluate retrospectively the outcomes of spontaneous early fetal loss and infertility. In addition, 87 workers participated in a cross-sectional evaluation of sperm/semen parameters. Due to the ever-changing nature of the exposure and the lack of quantification of specific exposures, six dichotomous variables were used for each specific job description to give a surrogate measure of exposure. Hence, no quantitative exposure-response relationships could be modeled. These six variables were independently assigned by two environmental hygienists, and their interrater reliability was assessed. Results are presented and further innovations in statistical methodology are proposed for further applications.
Blobel, Bernd; Pharow, Peter
While health systems in developed countries and increasingly also in developing countries are moving from organisation-centred to person-centred health service delivery, the supporting communication and information technology is faced with new risks regarding security and privacy of stakeholders involved. The comprehensively distributed environment puts special burden on guaranteeing communication security services, but even more on guaranteeing application security services dealing with privilege management, access control and audit regarding social implication and connected sensitivity of personal information recorded, processed, communicated and stored in an even internationally distributed environment.
Prather, Cynthia; Fuller, Taleria R; Marshall, Khiya J; Jeffries, William L
African American women are disproportionately affected by multiple sexual and reproductive health conditions compared with women of other races/ethnicities. Research suggests that social determinants of health, including poverty, unemployment, and limited education, contribute to health disparities. However, racism is a probable underlying determinant of these social conditions. This article uses a socioecological model to describe racism and its impact on African American women's sexual and reproductive health. Although similar models have been used for specific infectious and chronic diseases, they have not described how the historical underpinnings of racism affect current sexual and reproductive health outcomes among African American women. We propose a socioecological model that demonstrates how social determinants grounded in racism affect individual behaviors and interpersonal relationships, which may contribute to sexual and reproductive health outcomes. This model provides a perspective to understand how these unique contextual experiences are intertwined with the daily lived experiences of African American women and how they are potentially linked to poor sexual and reproductive health outcomes. The model also presents an opportunity to increase dialog and research among public health practitioners and encourages them to consider the role of these contextual experiences and supportive data when developing prevention interventions. Considerations address the provision of opportunities to promote health equity by reducing the effects of racism and improving African American women's sexual and reproductive health.
Prather, Cynthia; Fuller, Taleria R.; Marshall, Khiya J.; Jeffries, William L.
African American women are disproportionately affected by multiple sexual and reproductive health conditions compared with women of other races/ethnicities. Research suggests that social determinants of health, including poverty, unemployment, and limited education, contribute to health disparities. However, racism is a probable underlying determinant of these social conditions. This article uses a socioecological model to describe racism and its impact on African American women’s sexual and reproductive health. Although similar models have been used for specific infectious and chronic diseases, they have not described how the historical underpinnings of racism affect current sexual and reproductive health outcomes among African American women. We propose a socioecological model that demonstrates how social determinants grounded in racism affect individual behaviors and interpersonal relationships, which may contribute to sexual and reproductive health outcomes. This model provides a perspective to understand how these unique contextual experiences are intertwined with the daily lived experiences of African American women and how they are potentially linked to poor sexual and reproductive health outcomes. The model also presents an opportunity to increase dialog and research among public health practitioners and encourages them to consider the role of these contextual experiences and supportive data when developing prevention interventions. Considerations address the provision of opportunities to promote health equity by reducing the effects of racism and improving African American women’s sexual and reproductive health. PMID:27227533
Woodruff, Tracey J.; Carlson, Alison; Schwartz, Jackie M.; Giudice, Linda C.
The 2007 Summit on “Environmental Challenges to Reproductive Health and Fertility” convened scientists, health care professionals, community groups, political representatives and the media to hear presentations on the impact of environmental contaminants on reproductive health and fertility and to discuss opportunities to improve health through research, education, communication and policy. Environmental reproductive health focuses on exposures to environmental contaminants, particularly during critical periods of development, and their potential effects on future reproductive health, including conception, fertility, pregnancy, adolescent development and adult health. Approximately 87,000 chemical substances are registered for use in commerce in the US, with ubiquitous human exposures to environmental contaminants in air, water, food and consumer products. Exposures during critical windows of susceptibility may result in adverse effects with lifelong and even intergenerational health impacts. Effects can include impaired development and function of the reproductive tract and permanently altered gene expression, leading to metabolic and hormonal disorders, reduced fertility and fecundity and illnesses such as testicular, prostate, uterine and cervical cancers later in life. This executive summary reviews effects of pre- and post-natal exposures on male and female reproductive health and provides a series of recommendations for advancing the field in the areas of research, policy, health care and community action. PMID:18275883
Emans, S J; Brown, R T; Davis, A; Felice, M; Hein, K
This article is a revision of a 1983 position paper of the Society for Adolescent Medicine with inclusion of the newest medical advances in research on adolescent sexuality; i.e., contraceptive compliance, promotion of behavior change, relationships of ethnicity and pregnancy, and male reproductive health. The issues for the 1990's will be sexually transmitted diseases' morbidity and mortality. Topics identified are sexual activity and adolescent pregnancy, care of the pregnant teen, sexually transmitted diseases, HIV infection, the male adolescent, sexual abuse in adolescents, gay and lesbian youth, interventions, reproductive health care of adolescents with disabilities and chronic illnesses, and training of primary care physicians. The HIV/AIDS epidemic has focused attention on the reproductive behavior of males. Sexual activity varies by racial/ethnic group. Interventions to delay sexual initiation needs to be examined, although condom use has increased among 17-19 year olds from 21% to 58% in metropolitan areas. However condom use is lowest among the group of men at highest risk of STDs: those who had ever used drugs, those who had ever had sex with a prostitute, and those that had 5 or more partners/year. Male beliefs about contraception have been infrequently examined. There are misconceptions about heterosexual transmission of HIV. Better screening is needed for STD detection. Fathers are more involved in prenatal care and postnatal intervention programs. 7% of children have been subjected to nonvoluntary sexual intercourse between the ages of 18-21. ; i.e., 12.7% of white women, 9% of black women, 1.9% of white males, and 6.1% of black males. Risk factors for white women were living apart form parents at 16 years, poverty, physical and emotional limitations, parental alcohol and smoking and drug use. Sexual assault was associated with hitchhiking and alcohol and drug use in 1 study cited. Physicians need to be sensitive to this issue and probe for
Alayande, Audu; Mamman-Daura, Fatima; Adedeji, Olanike; Muhammad, Ado Zakari
Abstract Objectives: The significant improvement in the contraceptive prevalence rate in Kaduna State, Nigeria, from 8.4% in 2008 to 18.5% in 2013 is a notable achievement. This article analyses the role of midwives as drivers of reproductive health commodity security (RHCS) and their impact on contraceptive use in Kaduna State. Methods: The United Nations Population Fund (UNFPA) supported the bimonthly review resupply meetings facilitated by midwives at State and local government area (LGA) levels. The midwives deliver contraception to the LGAs for onward distribution to 6974 of the 25,000 health facilities across the country according to usage data from the previous 2 months. They also collect requisition, issue and resupply form data from the previous 2 months. Results: The active participation of midwives at the bimonthly meetings improved data timeliness by 23% and data completeness by 50% in 1 year. Only one health facility ran out of intrauterine devices and only 17% reported running out of female condoms. The total number of contraceptives issued increased from 31,866 in 2012 to 177,828 in 2013, resulting in a couple–year protection increase from 3408 in 2012 to 102,207 in 2013. Conclusions: Creation of increased demand and engagement of midwives in providing family planning services, especially long-acting contraceptive methods, coupled with the removal of cost to the user and the strengthening of the supply chain have been major factors in more than doubling the contraceptive prevalence rate. PMID:26909871
Mokhtar, Mazlin Bin; Murad, Wahid
Environmental health problems in Malaysia are mostly attributed to atmospheric pollution, water pollution, climate change, ozone depletion, and solid waste management, as well as toxic, chemical, and hazardous waste management. The Ministry of Health, Malaysia, has been vigorously pursuing the environmental health agenda by collaborating with other agencies at district, state, national, and international levels. This article discusses the issues and management framework of environmental health in Malaysia. Some issues requiring further investigation in order to clearly understand the trade-off between atmospheric change and environmental health are suggested. These suggestions are developed with particular reference to appraisals concerned with the development and implementation of environmental policy, programs, and practice. Research on the relevant issues is discussed and a framework is built involving a comprehensive review of the literature and existing framework of Malaysian environmental health.
Genuis, Stephen J
Although ongoing study is required to winnow environmental ideology from scientific fact, existing evidence from recent research demonstrates a definitive link between chemical toxicants and potential health sequelae, including congenital affliction and gynaecological disorders. Amid media clamour of health risk and biological peril associated with various environmental toxicants, a spectrum of responses has emerged: some have embraced the environmental cause, some have summarily dismissed it as piffle and perhaps the majority has remained disinterested. Although journals devoted to toxicological and environmental health concerns have become prominent in academia with voluminous numbers of scientific reports being published, there has been limited exploration of the relationship between contemporary chemical exposure and reproductive medical issues in mainstream obstetrics and gynaecology literature. Providers of obstetrical and gynaecological health care need to acquire knowledge of taking an exposure history, instruction in details of precautionary avoidance, skills to provide preconception care and necessary tools to investigate and manage patients with toxicant exposure.
In the Andean region of Latin America over one million adolescent girls get pregnant every year. Adolescent pregnancy (AP) has been associated with adverse health and social outcomes, but it has also been favorably viewed as a pathway to adulthood. AP can also be conceptualized as a marker of inequity, since it disproportionately affects girls from the poorest households and those who have not been able to attend school. Using results from a study carried out in the Amazon Basin of Ecuador, this paper explores APs and adolescents' sexual and reproductive health from a rights and gender approach. The paper points out the main features of a rights and gender approach, and how it can be applied to explore APs. Afterward it describes the methodologies (quantitative and qualitative) and main results of the study, framing the findings within the rights and gender approach. Finally, some implications that could be generalizable to global reserach on APs are highlighted. The application of the rights and gender framework to explore APs contributes to a more integral view of the issue. The rights and gender framework stresses the importance of the interaction between rights-holders and duty-bearers on the realization of sexual and reproductive rights, and acknowledges the importance of gender–power relations on sexual and reproductive decisions. A rights and gender approach could lead to more integral and constructive interventions, and it could also be useful when exploring other sexual and reproductive health matters. PMID:20596248
Gombachika, Belinda Chimphamba; Chirwa, Ellen; Malata, Address; Maluwa, Alfred
With wider access to antiretroviral therapy, people living with HIV are reconsidering their reproductive decisions: remarrying and having children. The purpose of the paper is to explore sources of information for reproductive decision used by couples living with HIV in patrilineal and matrilineal districts of Malawi. Data were collected from forty couples from July to December 2010. Our results illuminate five specific issues: some of the informants (1) remarry after divorce/death of a spouse, (2) establish new marriage relationship with spouses living with HIV, and (3) have children hence the need for information to base their decisions. There are (4) shared and interactive couple decisions, and (5) informal networks of people living with HIV are the main sources of information. In addition, in matrilineal community, cultural practices about remarriage set up structures that constrained information availability unlike in patrilineal community where information on sexual and reproductive health, HIV, and AIDS was disseminated during remarriage counselling. However, both sources are not able to provide comprehensive information due to complexity and lack of up to date information. Therefore, health workers should, offer people living with HIV comprehensive information that takes into consideration the cultural specificity of groups, and empower already existing and accepted local structures with sexual and reproductive health, HIV, and AIDS knowledge. PMID:23662206
Westad, Callie; McConnell, David
Many mothers with mental health issues are caught up in the child protection system and face the prospect of having their children removed from their care. The aim of this study was to determine prevalence and outcomes for mothers with mental health issues and their children in child maltreatment cases opened for investigation in Canada. The method was secondary analysis of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2003) core data. This CIS-2003 contains process and outcome data on a nationally representative sample of 11,652 child maltreatment investigations. Maternal mental health issues were noted in 2,272 (19.7%) cases opened for investigation. The most common child protection concerns were neglect, emotional maltreatment and exposure to domestic violence. A significant association was found between maternal mental health issues and child maltreatment investigation outcomes, with many potentially confounding variables held constant. Broad spectrum, multi-disciplinary services are needed to support mothers with mental health issues. Effective mental health care is vital but insufficient. Addressing trauma, strengthening social relationships and alleviating poverty are also key. Systemic advocacy is needed to ensure that mothers with mental health issues can access broad spectrum supports.
Autism is not a mental health disorder, but it sometimes is misdiagnosed as one--and can bring its own mental health issues. Dr Judith Gould explains how a mental health problem may mask an undiagnosed autistic spectrum disorder.
Remez, Lisa; Woog, Vanessa; Mhloyi, Marvelous
(1) As of 2011, 38% of young Zimbabwean women have had sex by age 18, as have 23% of young men; this difference has widened over time. Females now first have sex nearly two years sooner than males. (2) One-quarter of 15-19-year-old women have started childbearing; one-third of all births to adolescents are unplanned (wanted later or not at all). (3) Favorable trends of rising modern contraceptive use in urban areas were likely interrupted by the worst of the economic crisis in 2008. Use among married adolescents declined in urban areas (from 50% in 2006 to 29% in 2011), even as it rose in rural areas (from 30% to 37%). (4) Patterns in unmet need for contraception followed suit: In urban areas, the proportion of married adolescents who wanted to postpone childbearing but were not using a method rose between 2006 and 2011(from 14% to 28%); among their counterparts in rural areas, unmet need fell from 20% to 15% over this period. (5) Single, sexually active adolescents have by far the greatest unmet need--62% as of 2011, compared with 19% among their married counterparts. (6) Existing policies need clarification to assure that no adolescent is illegally denied services because of age. Youth-friendly sexual and reproductive health programs should be prioritized so today’s HIV-positive adolescents, many of whom have been infected since birth, do not transmit the virus to yet another generation.
Approximately 10 to 15% of couples are impacted by infertility. Recently, the pivotal role that lifestyle factors play in the development of infertility has generated a considerable amount of interest. Lifestyle factors are the modifiable habits and ways of life that can greatly influence overall health and well-being, including fertility. Many lifestyle factors such as the age at which to start a family, nutrition, weight, exercise, psychological stress, environmental and occupational exposures, and others can have substantial effects on fertility; lifestyle factors such as cigarette smoking, illicit drug use, and alcohol and caffeine consumption can negatively influence fertility while others such as preventative care may be beneficial. The present literature review encompasses multiple lifestyle factors and places infertility in context for the couple by focusing on both males and females; it aims to identify the roles that lifestyle factors play in determining reproductive status. The growing interest and amount of research in this field have made it evident that lifestyle factors have a significant impact on fertility. PMID:23870423
Violence--homicides, suicides, injuries caused by youth or family acts--continues in the United States. Firearms are involved in most incidents. The Centers for Disease Control and Prevention addresses the problem using the traditional tools of public health: epidemiologic data, individual and societal interventions based on the data, and ongoing evaluations to assess the effects of the interventions and change them if necessary. Examples of interventions are presented. PMID:7581313
Zampas, Christina; Andión-Ibañez, Ximena
The practice of conscientious objection often arises in the area of individuals refusing to fulfil compulsory military service requirements and is based on the right to freedom of thought, conscience and religion as protected by national, international and regional human rights law. The practice of conscientious objection also arises in the field of health care, when individual health care providers or institutions refuse to provide certain health services based on religious, moral or philosophical objections. The use of conscientious objection by health care providers to reproductive health care services, including abortion, contraceptive prescriptions, and prenatal tests, among other services is a growing phenomena throughout Europe. However, despite recent progress from the European Court of Human Rights on this issue (RR v. Poland, 2011), countries and international and regional bodies generally have failed to comprehensively and effectively regulate this practice, denying many women reproductive health care services they are legally entitled to receive. The Italian Ministry of Health reported that in 2008 nearly 70% of gynaecologists in Italy refuse to perform abortions on moral grounds. It found that between 2003 and 2007 the number of gynaecologists invoking conscientious objection in their refusal to perform an abortion rose from 58.7 percent to 69.2 percent. Italy is not alone in Europe, for example, the practice is prevalent in Poland, Slovakia, and is growing in the United Kingdom. This article outlines the international and regional human rights obligations and medical standards on this issue, and highlights some of the main gaps in these standards. It illustrates how European countries regulate or fail to regulate conscientious objection and how these regulations are working in practice, including examples of jurisprudence from national level courts and cases before the European Court of Human Rights. Finally, the article will provide recommendations
In 1984, in Mexico City, the Reagan administration announced its policy prohibiting USAID from supporting any nongovernmental organization which used its own or US funds for any abortion-related activities. Even though this policy was intended to reduce the incidence of abortion, it had the opposite effect because the cut in funding left some areas of the developing world with no family planning services or information at all. Further, this policy resulted in a loss of $17 million (US) or 25% of the budget of the International Planned Parenthood Federation (IPPF). On January 22, 1993, US President Clinton reversed this policy. IPPF considered President Clinton's action to be a significant event for women's health, human rights, and global development. This reversal will provide family planning services to about 300 million couples who want to practice family planning but could not do so because they did not have access to it. SHortly after President Clinton's announcement, IPPF began writing a proposal to USAID for funds to restore programs that the Mexico City policy eliminated. IPPF hoped the reversal would spark international recognition of the need for safe access to abortion. Other actions President Clinton has taken to promote reproductive health are reversing the Reagan and Bush administrations' rule prohibiting abortion counseling at federally-funded clinics, requesting that the US Food and Drug Administration study the possible marketing of RU-486, removing the ban on abortion in military hospitals, approving regulations allowing fetal tissue research, and appointing an abortion rights advocate as Surgeon General. The Catholic Church opposed all of Clinton's abortion policies. However, many congregations, priests, and Vatican officials are dissatisfied with the Pope's anticontraception position.
Locke, Ben; Wallace, David; Brunner, Jon
This chapter provides a brief overview of the psychological issues facing today's college students, information about students receiving mental health services, and an evidence-based model describing the practice and functions of today's counseling centers.
Mprah, Wisdom Kwadwo; Anafi, Patricia; Sekyere, Frank Owusu
Gaps in national Ghanaian sexual and reproductive health (SRH) policies and research in terms of attention given to persons with disabilities are identified and ways to redirect policies to include them suggested. Policies and research in seven major documents from government sources and non-governmental organizations were reviewed for policy and practice statements relevant to disability to determine if and how they addressed SRH concerns of persons with disabilities. The findings indicated attention given to persons with disabilities has been cursory. There is need for more attention on disability issues in SRH research and policies to make the needs of persons with disabilities visible and to guide and provide disability-friendly services and information.
Svanemyr, Joar; Amin, Avni; Robles, Omar J; Greene, Margaret E
This article provides a conceptual framework and points out the key elements for creating enabling environments for adolescent sexual and reproductive health (ASRH). An ecological framework is applied to organize the key elements of enabling environments for ASRH. At the individual level, strategies that are being implemented and seem promising are those that empower girls, build their individual assets, and create safe spaces. At the relationship level, strategies that are being implemented and seem promising include efforts to build parental support and communication as well as peer support networks. At the community level, strategies to engage men and boys and the wider community to transform gender and other social norms are being tested and may hold promise. Finally, at the broadest societal level, efforts to promote laws and policies that protect and promote human rights and address societal awareness about ASRH issues, including through mass media approaches, need to be considered.
The 1994 International Conference on Population and Development (ICPD) in Cairo marked a paradigm shift that took family planning out of a population control context and into the broader context of sexual and reproductive health and rights (SRHR). While progress has been made with increased access to family planning and a decrease in maternal deaths, we have not seen practical results for the majority of women and girls worldwide, who still experience unacceptably high rates of maternal deaths, unmet contraceptive needs and HIV infections. Three of the compromises made by governments at Cairo - integration, reproductive rights and resource allocation - hindered the fulfilment of women's and girls' SRHR. The post-2015 agenda must ensure that economic development and global health interventions are linked at the national and global levels; family planning, HIV, maternal health and other reproductive health services are integrated and delivered through primary health settings; and access to safe and voluntary abortion services is recognised as a human right. Non-governmental organisations and donors must move beyond siloed issue areas to challenge governments, multilateral agencies, the financial sector and each other to ensure that the promise of SRHR is realised.
Amchova, Petra; Kotolova, Hana; Ruda-Kucerova, Jana
Increasing attention has been recently paid to the toxicity of additives used in food. The European Parliament and the Council published the REGULATION (EC) No. 1333/2008 on food additives establishing that the toxicity of food additives evaluated before 20th January 2009 must be re-evaluated by European Food Safety Authority (EFSA). The aim of this review is to survey current knowledge specifically on the toxicity issues of synthetic food colorants using official reports published by the EFSA and other available studies published since the respective report. Synthetic colorants described are Tartrazine, Quinoline Yellow, Sunset Yellow, Azorubine, Ponceau 4R, Erythrosine, Allura Red, Patent Blue, Indigo Carmine, Brilliant Blue FCF, Green S, Brilliant Black and Brown HT. Moreover, a summary of evidence on possible detrimental effects of colorant mixes on children's behaviour is provided and future research directions are outlined.
Gulzar, Saleema Aziz; Vertejee, Samina; Pirani, Laila
Child labour is a global practice and has many negative outcomes. According to International Labour Organization, child labour is the important source of child exploitation and child abuse in the world today. The Human Rights Commission of Pakistan has estimated the number of Pakistani working children to be around 11-12 millions, out of which, at least, half the children are under the age of ten years. It portrays the society's attitude towards child care. It is therefore, essential to break this vicious cycle and hence, enable the society to produce healthy citizens. This article analyzes the determinants of child labour in the Pakistani context and its implications for child's life, in specific, and for the nation, in general, utilizing the model developed by Clemen-stone & McGuire (1991). Since this practice has complex web of causation, a multidisciplinary approach is required to combat this issue through proposed recommendations.
Pacifici, L E; Riccardo, F; De Rosa, A G; Pacini, A; Nardi, L; Russo, G; Scaroni, E
Recent studies show how in the 2004-2005 period there has been an increase in natural disasters of 18% worldwide. According to a renowned author planning for disaster response is as valid as the starting hypothesis. The study of an inductive mental process in disaster response planning is the key to avoiding the invention and re-invention of the wheel for each emergency. Research in this field however is hampered by different factors one of which is data collection that during disaster response requires specific training. Standardization of data collection models with limitation of the number of variables is required as is taking into account problems related to people migration and subsequent sampling problems and retrospective analysis. Moreover poor attention to the training of the volunteers employed on the field is an issue to be considered.
Neider, John R.; And Others
This paper examines critical issues for states and advocacy groups in trying to develop short-term goals to address mental health needs of refugees and to plan long-term strategies for state and county service systems for this population. The paper begins with a discussion of the following issues: (1) centralized versus decentralized state mental…
Blewett, Lynn A; Parente, Stephen T; Finch, Michael D; Peterson, Eileen
A national data warehouse that links public and private data could be used to monitor trends in healthcare costs, utilization, quality of care, and adherence to quality guidelines and changes in treatment protocols. The development of the data warehouse, however, would require overcoming a number of political and technical challenges to gain access to private insurance data. This article outlines recommendations from a national conference sponsored by the Agency for Healthcare Research and Quality (AHRQ) on the private sector's role in quality monitoring and provides an operational outline for the development of a national private sector health data warehouse.
Collins, J L
Journalists witness events and report the news. The gathering and presentation of this information may subject the journalist to a variety of physical and psychological hazards. Some health and safety risk factors are inherent within the profession: for example, stress associated with deadlines and reporting on events in dangerous climactic or social conditions. Survey data and information collected by professional journalism associations should be used to educate journalists and, whenever possible, to attenuate the risk factors. Some of the more common risks within the profession include those relating to travel, repetitive strain, and psychological stress.
Public policy documents on gender and health mostly rely on categorical understandings of gender that are now inadequate. Poststructuralist thought is an advance, but relational theories of gender, treating gender as a multidimensional structure operating in a complex network of institutions, provide the most promising approach to gendered embodiment and its connection with health issues. Examples are discussed in this article. A crucial problem is how to move the analysis beyond local arenas, especially to understand gender on a world scale. A relational approach to this question is proposed, seeing gendered embodiment as interwoven with the violent history of colonialism, the structural violence of contemporary globalization, and the making of gendered institutions on a world scale, including the corporations, professions and state agencies of the health sector. Gender is seen as the active social process that brings reproductive bodies into history, generating health consequences not as a side-effect but in the making of gender itself.
Belleh, G S; Akhigbe, O O
Economic issues are among the most important factors affecting health sciences libraries in Nigeria. These issues are influenced by the political, cultural, geographic, and demographic characteristics of the country. Significant economic issues are the dependence of the national economy on a single commodity, large foreign debt and spiraling inflation, stringent foreign exchange control measures, and inadequate realization by authorities of the role and importance of health sciences libraries. With shrinking budgets, resources, and staff, health sciences libraries can neither grow nor afford library automation. Health sciences librarians must take initiatives for cooperative activities to increase and make the most of resources, pursue nontraditional methods of fund-raising, educate authorities about the role and importance of libraries, and develop and implement a plan for the development and growth of health sciences libraries in the country. PMID:1884083
Cole, David W; Cole, Richard; Gaydos, Steven J; Gray, Jon; Hyland, Greg; Jacques, Mark L; Powell-Dunford, Nicole; Sawhney, Charu; Au, William W
Aquaculture is one of the fastest growing food-producing sectors, supplying approximately 40% of the world's fish food. Besides such benefit to the society, the industry does have its problems. There are occupational hazards and safety concerns in the aquaculture industry. Some practices have caused environmental degradation. Public perception to farmed fish is that they are "cleaner" than comparable wild fish. However, some farmed fish have much higher body burden of natural and man-made toxic substances, e.g. antibiotics, pesticides, and persistent organic pollutants, than wild fish. These contaminants in fish can pose health concerns to unsuspecting consumers, in particular pregnant or nursing women. Regulations and international oversight for the aquaculture industry are extremely complex, with several agencies regulating aquaculture practices, including site selection, pollution control, water quality, feed supply, and food safety. Since the toxicological, environmental, and health concerns of aquaculture have not been adequately reviewed recently, we are providing an updated review of the topic. Specifically, concerns and recommendations for improving the aquaculture industry, and for protection of the environment and the consumers will be concisely presented.
This paper describes a three-year long research project in which nine large-bodied women have engaged in a prolonged dialogue with the researcher about the experience of being 'obese'. The study involved an extensive review of the multidisciplinary literature that informs our understandings of body size. The literature review was shared with participants in order to support their critical understanding of their experience. An examination of a wide range of literature pertinent to the area of study reveals widespread acceptance of the notion that to be thin is to be healthy and virtuous, and to be fat is to be unhealthy and morally deficient. The experience of participants raised questions as to how nursing could best provide health-care for large women. According to the literature review, nurses have perpetuated an unhelpful and reductionist approach to their care of large women, in direct contradiction to nursing's supposed allegiance to a holistic approach to health-care. This paper suggests strategies for an improved response to women who are concerned about their large body size.
Background The continued poor sexual and reproductive health (SRH) outcomes in sub-Saharan Africa highlight the difficulties in reforming policies and laws, and implementing effective programmes. This paper uses one international and two national case studies to reflect on the challenges, dilemmas and strategies used in operationalising sexual and reproductive health and rights (SRHR) in different African contexts. Methods The international case study focuses on the progress made by African countries in implementing the African Union’s Maputo Plan of Action (for the Operationalisation of the Continental Policy Framework for Sexual and Reproductive Health and Rights) and the experiences of state and non-state stakeholders in this process. The case was developed from an evaluation report of the progress made by nine African countries in implementing the Plan of Action, qualitative interviews exploring stakeholders’ experiences and perceptions of the operationalisation of the plan (carried out as part of the evaluation) in Botswana and Nigeria, and authors’ reflections. The first national case study explores the processes involved in influencing Ghana’s Domestic Violence Act passed in 2007; developed from a review of scientific papers and organisational publications on the processes involved in influencing the Act, qualitative interview data and authors’ reflections. The second national case study examines the experiences with introducing the 2006 Sexual Offences Act in Kenya, and it is developed from organisational publications on the processes of enacting the Act and a review of media reports on the debates and passing of the Act. Results Based on the three cases, we argue that prohibitive laws and governments’ reluctance to institute and implement comprehensive rights approaches to SRH, lack of political leadership and commitment to funding SRHR policies and programmes, and dominant negative cultural framing of women’s issues present the major
Simba, Daudi O; Kakoko, Deodatus C
Out-of-school peer educators [PE] are resourceful in transmitting reproductive health information but their retention remains a contentious issue. This study aimed to assess motivation and sustainability of out-of-school PEs in disseminating reproductive health information among adolescents. A structured questionnaire was used to interview 406 PEs in Mbeya region, Tanzania. Focus Group Discussions [FGDs] were also conducted with the PEs and other relevant stakeholders. Most PEs had hopes for future employment and allowances through continuous training. The fact that majority of PEs had primary level education [89%] and were either peasants or self employed [92%] posed a serious question as to whether voluntary work is for the less educated, peasants and self-employed. Sustenance of PEs needs to be a continuous activity aimed at increasing the number of trained adolescents from their own social and economic groups. Otherwise, provision of transport and compensation for time spent should be considered.
Palloni, Alberto; Milesi, Carolina; White, Robert G; Turner, Alyn
The persistence of adult health and mortality socioeconomic inequalities and the equally stubborn reproduction of social class inequalities are salient features in modern societies that puzzle researchers in seemingly unconnected research fields. Neither can be satisfactorily explained with standard theoretical frameworks. In the domain of health and mortality, it is unclear if and to what an extent adult health and mortality disparities across socioeconomic status (SES) are the product of attributes of the positions themselves, the partial result of health conditions established earlier in life that influence both adult health and economic success, or the outcome of the reverse impact of health status on SES. In the domain of social stratification, the transmission of inequalities across generations has been remarkably resistant to satisfactory explanations. Although the literature on social stratification is by and large silent about the role played by early health status in shaping adult socioeconomic opportunities, new research on human capital formation suggests this is a serious error of omission. In this paper we propose to investigate the connections between these two domains. We use data from male respondents of the 1958 British Cohort to estimate (a) the influence of early health conditions on adult SES and (b) the contribution of early health status to observed adult health differentials. The model incorporates early conditions as determinants of traits that enhance (inhibit) social mobility and also conventional and unconventional factors that affect adult health and socioeconomic status. Our findings reveal that early childhood health plays a small, but non-trivial role as a determinant of adult SES and the adult socioeconomic gradient in health. These findings enrich current explanations of SES inequalities and of adult health and mortality disparities. PMID:19269728
Sorrentino, Eugenio; Vona, Rosa; Monterosso, Davide; Giammarioli, Anna Maria
The increasing proportion of women in the workforce raises a range of gender-related questions about the different effects of work-related risks on men and women. Few studies have characterized gender differences across occupations and industries, although at this time, the gender sensitive approach is starting to acquire relevance in the field of human preventive medicine. The European Agency for Safety and Health at Work has encouraged a policy of gender equality in all European member states. Italy has adopted European provisions with new specific legislation that integrates the previous laws and introduces the gender differences into the workplace. Despite the fact that gender equal legislation opportunities have been enacted in Italy, their application is delayed by some difficulties. This review examines some of these critical aspects.
Mahaffey, Kathryn R
Mercury exposure is widespread in the United States with methylmercury as the predominant chemical species and fish and shellfish as the source. Use of more advanced diagnostic techniques and application of population-based risk assessment methodologies have assisted in addressing the impact of mercury exposure on the United States population. Biomonitoring, particularly through analyses of blood mercury, provides both population-based data and exposure information that can be informative for physicians. Data from the National Health and Nutrition Examination Survey (NHANES) beginning in 1999 provide population-based exposure estimates for United States overall. Methylmercury exposures among women of childbearing age are of particular concern because of methylmercury's developmental neurotoxicity. Exposures of concern among women are estimated to occur in between ∼6% to 8% of the 16-to-49-year-old age group based on data from NHANES; and in ∼15% of this age and sex group if physiological factors such as the degree of transplacental transport of methylmercury are taken into consideration. Subgroups with high fish consumption (e.g., many island and coastal populations, some persons of Asian ethnicity, some individuals following “healthy” diets) can have methylmercury exposures substantially higher than those reported among the NHANES examinees. These subpopulations are not likely to be aware of their blood mercury concentrations or the possible health outcomes associated with such high blood mercury levels. The American Medical Association has adopted policies that express concerns about methylmercury exposure, and advise patient education. Non-neurological risks for adults associated with methylmercury, including the potential for adverse cardiac outcomes, have not yet been incorporated into risk assessments. PMID:16555611
Elders, M J
The state of US children's health and recommendations for improvement are reported. The 1st table identifies youth as risk, i.e., at the current rate, 1 in 10 women will give birth by the time they turn 18. Among black children, white children 1-4 years, and blacks 15-24 years, death rates actually increased from 1985 to 1987. Injuries, particularly due to violence, have replaced communicable diseases as the primary cause of death among adolescents. Since 1976, immunization has deteriorated. There is a refusal to recognize sexually active adolescents, in spite of 2.5 million cases of sexually transmitted disease. The 6 strategies discussed intervention begin with providing high quality preschool education programs for all children. The 2nd urges educational programs from kindergarten through 12th grade that help children make healthy choices, improve their self-esteem, and accept as much responsibility for their own lives as possible. Parenting education, as the 3rd strategy, promotes the education and support of parents, especially for young and poor parents. The 4th strategy involves male responsibility and instruction on obligations in pregnancy and parenthood, including a requirement of financial commitment from fathers and identification of the father by Social Security number on an infant's birth certificate. The 5th strategy is the provision for school-based health services, including family life counseling and contraceptive services for adolescents. The 6th strategy is to provide free college tuition and books at a state supported school for students with at least a B average, good citizenship record, and a family income of $20,000. It is cheaper to offer children opportunity than to pay the costs of the consequences of poverty.
Aldridge, Jerry; Kohler, Maxie
Issues concerning the health and safety of children and youth occur at multiple levels. Bronfenbrenner (1995) proposed an ecological systems approach in which multiple systems interact to enhance or diminish children's development. The same systems are at work in health promotion. The authors present and review articles that reflect the multiple…
Resnik, David B
This article reviews some of the ethical issues that arise in environmental health research with human subjects, such as minimizing risks to subjects, balancing benefits and risks in research, intentional exposure studies with human subjects, protecting third parties in research, informing subjects about environmental hazards, communicating health information to subjects, and protecting privacy and confidentiality.
Resnik, David B.
This article reviews some of the ethical issues that arise in environmental health research with human subjects, such as minimizing risks to subjects, balancing benefits and risks in research, intentional exposure studies with human subjects, protecting third parties in research, informing subjects about environmental hazards, communicating health information to subjects, and protecting privacy and confidentiality. PMID:20401332
Howze, Dorothy C.; And Others
Reviewing health related "costs" of female labor force participation, this paper examines four highly salient maternal and child health issues. Discussion of acute illness in day care settings begins with an overview of studies on day care and illness and focuses on hepatitis A, appropriate sanitation, and indications of research on…
Grace, Kristen S; Sinclair, Kevin D
Live birthrates following assisted reproduction account for 1 to 3% of pregnancies in developed countries, and these figures seem set to rise. Concerns regarding the safe use of assisted reproductive technology (ART) for the treatment of infertility have been voiced for several years, yet, to date, the vast majority of children conceived using these techniques are apparently normal. Controversy surrounding reports of epigenetic alterations to genomic imprinting following human ART in recent years has fueled the ongoing debate. In contrast, both the incidence and severity of such anomalies are more apparent following ART in comparative animal species. The reasons for this are not known. By and large, the confounding effects of infertility and advanced maternal age do not apply to animal studies, which report better pregnancy rates following embryo transfer. Perhaps the incidence of imprinting disorders is increased when procedures such as ovarian stimulation, in vitro maturation, or both are used in conjunction with extended periods of embryo culture; this frequently occurs in animal but rarely in human ART. The focus of attention on imprinting, however, may have served to distract the scientific community from more subtle epigenetic modifications to nonimprinted loci in gametes and the preimplantation embryo, with health-related consequences that do not manifest until adulthood. Accumulating evidence from animal studies indicates that such effects, not yet apparent in human subjects, exist; and this may ultimately transpire to be the true developmental legacy of human ART. This article discusses these issues in the context of epigenetic and developmental abnormalities following ART in animals.
Crane, Barbara B; Dusenberry, Jennifer
Since 2001, the US government has used its power as a leading donor to family planning programmes to pursue policies in conflict with global agreements on reproductive rights. Prominent among these policies is the Mexico City Policy (or Global Gag Rule), which restricts non-governmental organisations (NGOs) in developing countries that receive USAID family planning funding from engaging in most abortion-related activities, even with their own funds. This paper reviews the history and political origins of the Gag Rule under several Republican party presidents. The Gag Rule has not achieved an overall reduction in abortions; rather, where it has disrupted family planning services, the policy is more likely to have increased the number of abortions. This paper concludes that the Gag Rule is a radical intrusion on the rights and autonomy of recipients of US funding. Regardless of whether or not it is rescinded in the future, the underlying issues in the politics of US reproductive health assistance are likely to persist. NGOs that wish to free themselves from the constraints it imposes must find the means to end their dependence on USAID funding, including turning to other donors. NGOs should also take the lead in opposing policies such as the Gag Rule that violate global agreements.
Friedman, Maria A.
This issue of the Health Care Financing Review focuses on issues and advances in measuring and improving the quality of care, particularly for Medicare and Medicaid beneficiaries. Discussions of quality-related topics are especially timely, given the growing and widespread interest in improving quality in the organization, financing, and delivery of health care services. This article has several purposes. The first is to provide a brief description of some of the causes underlying the growth of the health care quality movement; the second is to provide a contextual framework for discussion of some of the overarching themes that emerge in this issue. These themes include examining conceptual issues, developing quality measures for specific sites and populations, and creating or adapting data sets for quality-measurement purposes. PMID:10151882
Rafferty, Anthony R; Scheelings, T Franciscus; Foley, Laura J; Johnstone, Christopher P; Reina, Richard D
Life-history theory predicts that a trade-off in the allocation of resources between different physiological systems exists because resources are finite. As a result, females investing heavily in reproduction may compromise their future health. We used hematology, serum biochemistry, mass, and morphometric measurements as indicators of physiological health state to investigate whether reproductive investment altered subsequent maternal health in three Australian freshwater turtles: the oblong turtle (Chelodina oblonga; n = 12), the Macquarie turtle (Emydura macquarii; n = 9), and the eastern long-necked turtle (Chelodina longicollis; n = 8). Maternal health was impaired in turtles that produced larger and heavier eggs and clutches. In C. oblonga and E. macquarii, increased reproductive investment generally resulted in negative changes to the hematology and serum biochemistry profile of maternal blood. Generally, increases in heterophil/lymphocyte ratio, aspartate transaminase, creatine kinase, calcium/phosphorus ratio, and albumin/globulin ratio were observed following reproduction, in addition to a decrease in glucose and total protein. These findings agree with the physiological constraint hypothesis and highlight the connection between life-history evolution and animal physiology by documenting, for the first time, how measures of physiological health state relate to reproductive investment in Australian freshwater turtles. Additionally, our findings suggest that body condition, a readily used morphological biomarker, is a poor predictor of health in turtles. Our results emphasize the need to investigate how maternal health is influenced by the reproductive process in different species.
Shigemura, Jun; Nomura, Soichiro
The end of the Cold War has brought a dramatic change to the international political situation and the role of the United Nations peacekeeping operations (PKO) has drawn increased attention. While many reports on PKO have focused on political or sociologic considerations, the mental health of the peacekeepers themselves has received little attention and psychiatric problems that can have a negative impact on mission success have been largely ignored. Participation in PKO creates a number of stressors and serious psychiatric and/or physical disorders may result. Yet, there is little research on this topic, either domestically or globally, and the methodology for clinical intervention remains in an early stage of development. We have reviewed previous reports to determine how various stressors before, during and after deployment affect the participants. Research in associated fields (e.g. crisis workers and military personnel) are also reviewed and their application to peacekeeping psychiatry is discussed. It must be admitted that the significance of PKO is arguable and each PKO is unique in terms of the nature of its mission and the local situation. Yet, the relationship between the psychiatric status of the personnel and the characteristics of an individual mission has never been studied. At present, no clear consensus regarding a framework for psychiatric intervention exists. Studies that enhance the recognition and significance of peacekeeping psychiatry are likely to improve the efficacy of PKO.
Basit, Abdul; Hamid, Mohammad
The underpinning of all research leading to various schools of thought in the field of psychiatry and psychology is without doubt a product of Western professionals who represent the religio-cultural traditions, historical symbols, and narratives of Western society. Also, the major schools of psychotherapy emerged during an era of individualism and logical positivism reflecting the religious, ethical, and cultural heritage that has shaped the modern Western society. Consequently, the methods and techniques developed in the West may not be always suitable and effective for Muslim Americans. To respond to the growing needs of psychiatric problems encountered by Muslim Americans, many community social service centers have been established in the United States during the past two decades. We now have a growing body of research data suggesting how to tailor our field to the specific needs of this population. We will discuss what kind of emotional and psychiatric problems are most prevalent in Muslim Americans and explain the therapeutic approaches mental health professionals have used and the treatment strategies which have been found effective in the psychosocial rehabilitation of Muslim Americans. PMID:23864761
Basit, Abdul; Hamid, Mohammad
The underpinning of all research leading to various schools of thought in the field of psychiatry and psychology is without doubt a product of Western professionals who represent the religio-cultural traditions, historical symbols, and narratives of Western society. Also, the major schools of psychotherapy emerged during an era of individualism and logical positivism reflecting the religious, ethical, and cultural heritage that has shaped the modern Western society. Consequently, the methods and techniques developed in the West may not be always suitable and effective for Muslim Americans. To respond to the growing needs of psychiatric problems encountered by Muslim Americans, many community social service centers have been established in the United States during the past two decades. We now have a growing body of research data suggesting how to tailor our field to the specific needs of this population. We will discuss what kind of emotional and psychiatric problems are most prevalent in Muslim Americans and explain the therapeutic approaches mental health professionals have used and the treatment strategies which have been found effective in the psychosocial rehabilitation of Muslim Americans.
Sevig, Umit; Yilmaz, Senay; Başer, Mürüvvet; Taşci, Sultan
The Turkish Armed Forces Commando Brigade has started a continuous and systematic education program, called the Patriotic Awareness Acquirement Project (PCAP), to inform soldiers who will be demobilized. Within the PCAP, topics such as Turkish history, the Armenian question, and manners/etiquette, as well as healthy living, reproductive health, family planning, general hygiene, and sexually transmitted diseases were included. The aim of Reproductive Health Education (RHE) conducted within the PCAP is to inform male individuals about reproductive health and to increase their knowledge, awareness, and sensitivity. In the RHE, the privates were provided with information regarding male and female reproductive organs, the menstruation mechanism, pregnancy, determination of gender, fertility-infertility, and sexually transmitted diseases. After the evaluation, it was reported that the privates indicated they were satisfied with RHE, were informed, took notice of the incorrect information, and, for postmilitary life, would visit health clinics for counseling.
Wright, Rachel L; Bird, Melissa; Frost, Caren J
Reproductive health is an important area affecting a woman's overall health and well-being. The examination of reproductive health and barriers to care is pertinent to the social work profession and should be a focus of social work practice, education, research, and advocacy. The authors conducted a literature search of articles published in the social work literature from 2010 to 2014. The findings reveal important published articles that increase our knowledge of the reproductive health of women in the United States. Most published articles focused on pregnancy and birth outcomes. Articles also addressed sexually transmitted infections; abortion; intimate partner violence; prostitution; access to care; cancer screening; views toward contraception; hysterectomies; breastfeeding; menopause; and the intersection of reproductive rights, religion, and social justice. This review also identified unexamined areas that require further social work attention and consideration.
Khani, S; Moghaddam-Banaem, L; Mohamadi, E; Vedadhir, A A; Hajizadeh, E
No tools to assess women's general sexual and reproductive health needs have been validated in the Iranian context. This study in Sari in Mazandaran province of the Islamic Republic of Iran was conducted to evaluate the psychometric properties of a Persian version of the Sexual and Reproductive Health Needs Assessment Questionnaire (first developed for the International Organization for Migration and United Nations Population Fund). The Persian version of the questionnaire was found to have adequate face and content validity (quantitative and qualitative) for assessing sexual and reproductive health needs among women (content validity index = 0.88). The test-retest reliability showed that, except for the domain of sexually transmitted infections, all domains of the questionnaire had an acceptable reliability (intra-class correlation coefficients > 0.5). This questionnaire is a valid tool for assessing the sexual and reproductive health needs of Iranian women and planning/designing strategies to meet them.
McKee, Martin; Gilmore, Anna B; Schwalbe, Nina
The world is increasingly shaped by powerful global forces, many of which have consequences for human health and the social, economic, and environmental factors that influence health are increasingly determined at a supranational level. As a result, local or national level efforts to influence health determinants can have only a limited impact and it is all too easy for the individual public health practitioner to feel powerless. Yet while public health practitioners, on their own, may indeed be comparatively powerless, together they can achieve a great deal. Part I of this glossary explores a range of issues that arise as they seek to make a difference.
Long, Michelle; Menifield, Charles E; Fletcher, Audwin B
Health care spending is often addressed in discussions of budgeting and deficits in the United States. It is important to many Americans that funds allocated for health care spending be allocated and spent in the most efficient and effective manner, leading to improved health outcomes, particularly for underserved populations. Many studies address health care spending, but few address the issue of spending as it relates to societal well-being, or certain health outcomes that adversely impact communities. This study seeks to expand the available literature by analyzing data from national sources at the state level.
Kilgour, Lindsey; Matthews, Nic; Christian, Polly; Shire, Jo
Health literacy (HL) is a relatively new concept in health promotion and is concerned with empowering people through enhancing their knowledge of health issues and improving their ability to make choices about their health and well-being. Schools are seen increasingly as key settings for the dissemination of health messages through curricula and…
Nizamov, I G; Chechulina, O V
The reproductive health of teenagers deserves a special attention and must be regarded from the viewpoint of their future prospects as well as their social and cultural media. The mentioned social-and-cultural factors affecting the teenagers' attitude towards sexuality and preconditioning their access to information and services of healthcare have an impact on the status of their reproductive health and on their general well-being, including the ability of teenagers to avoid an undesired pregnancy or sexually transmitted diseases.
Chavkin, W; Busner, C; Mclaughlin, M
"People from the Caribbean represent one of the largest immigrant groups in New York City. This study focuses on the reproductive health of first generation Caribbean immigrants. Birth and death certificate data were used to generate descriptive profiles of risk-factor prevalence and reproductive outcomes to Caribbean and comparison populations." Data on single live births for 1980-1984 take into consideration ethnic differences, age, place of birth, parity, mother's education, method of payment for health care, prenatal care, and birth weight.
Tangcharoensathien, Viroj; Tantivess, Sripen; Teerawattananon, Yot; Auamkul, Nanta; Jongudoumsuk, Pongpisut
Thailand has recently introduced universal health care coverage for 45 million of its people, financed by general tax revenue. A capitation contract model was adopted to purchase ambulatory and hospital care, and preventive care and promotion, including reproductive health services, from public and private service providers. This paper describes the health financing system prior to universal coverage, and the extent to which Thailand has achieved reproductive health objectives prior to this reform. It then analyses the potential impact of universal coverage on reproductive health services. Whether there are positive or negative effects on reproductive health services will depend on the interaction between three key aspects: awareness of entitlement on the part of intended beneficiaries of services, the response of health care providers to capitation, and the capacity of purchasers to monitor and enforce contracts. In rural areas, the district public health system is the sole service provider and the contractual relationship requires trust and positive engagement with purchasers. We recommend an evidence-based approach to fine-tune the reproductive health services benefits package under universal coverage, as well as improved institutional capacity for purchasers and the active participation of civil society and other partners to empower beneficiaries.
Bayrami, Roghieh; Roudsari, Robab Latifnejad; Allahverdipour, Hamid; Javadnoori, Mojgan; Esmaily, Habibollah
Introduction Despite the beginnings of preconception care (PCC) delivery around a decade ago in Iran, there are still significant gaps in its service delivery. The purpose of this study was to explore the perceptions and experiences of women as well as midwives toward gaps in PCC delivery in the Iranian reproductive health care system. Methods In this exploratory qualitative study, 27 married women and 13 midwives were recruited using purposive sampling from five health centers in Mashhad, Northeast of Iran. Respondents participated in semi-structured, in-depth, individual and focus-group interviews to express their perceptions and experiences about gaps in PCC. Data were analyzed using conventional content analysis adopted by of Graneheim and Lundman (2004) with MAXQDA software. Results Analysis of data revealed four themes: 1) missing men and adolescents from PCC; 2) insufficient PCC package; 3) inadequate PCC strategies; and 4) health care providers’ incompetency. Conclusion It is recommended to deliver gender-sensitive PCC through addressing couples’ instead of just women’s PCC and to take into account the adolescent girls’ health in order to improve their preconception health. Standardization of protocols and attention of health professionals toward occupational–environmental hazards and sexual and reproductive issues as well as enhancing professional capability of health care providers could improve PCC service delivery. PMID:28070262
Sousa, Isabela Cabral Felix de
A health education program in Brazil trained 26 women as community health educators. Only four used their roles to foster social change. Discussing women's reproductive health in the context of religion and social values contributed to successful training; economic and political empowerment was hampered by perpetuation of traditional role…
Freudenberg, Nicholas; Ruglis, Jessica
Good education predicts good health, and disparities in health and in educational achievement are closely linked. Despite these connections, public health professionals rarely make reducing the number of students who drop out of school a priority, although nearly one-third of all students in the United States and half of black, Latino, and American Indian students do not graduate from high school on time. In this article, we summarize knowledge on the health benefits of high school graduation and discuss the pathways by which graduating from high school contributes to good health. We examine strategies for reducing school dropout rates with a focus on interventions that improve school completion rates by improving students' health. Finally, we recommend actions health professionals can take to reframe the school dropout rate as a public health issue and to improve school completion rates in the United States.
Millner, L; Widerman, E
To assess the ways in which social work is addressing issues in women's health care, the profession's journals from 1985-1992 were searched, yielding 36 articles. Over half addressed issues of reproduction and sexuality including pregnancy, family planning, abortion, substance abuse in pregnancy, and fetal protection policies. Remaining articles addressed medical diagnoses; including AIDS/HIV/STDs, cancer, illnesses associated with aging, PMS, Turner's Syndrome, and chronic fatigue syndrome. Foci, methodologies, and recommendations are discussed and the authors critically analyze the articles' reflections of the status of women's health as a social work concern.
Lema, V M
Lack of access to quality reproductive health services is the main contributor to the high maternal mortality and morbidity in sub-Saharan Africa (SSA). This is partly due to a shortage of qualified and experienced health care providers. However conscientious objection amongst the available few is a hitherto undocumented potential factor influencing access to health care in SSA. Provision of certain reproductive health services goes counter to some individual's religious and moral beliefs and practices. Health providers sometimes refuse to participate in or provide such services to clients/patients on moral and/or religious grounds. While the rights to do so are protected by the principles of freedom of religion, among other documents, their refusal exposes clients/patients to the risk of reproductive health morbidity as well as mortality. Such providers are required to refer the clients/patients to other equally qualified and experienced providers who do not hold similar conscientious objection. Access to high quality and evidence-based reproductive health services by all in need is critical to attaining MDG5. In addressing factors contributing to delay in attaining MDG5 in SSA it is instructive to consider the role of conscientious objection in influencing access to quality reproductive health care services and strategies to address it.
Germain, Adrienne; Sen, Gita
Abstract The Programme of Action of the International Conference on Population and Development (ICPD) held in Cairo in 1994 offers a comprehensive framework for achieving sexual and reproductive health and rights, including the prevention and treatment of HIV/AIDS, and for advancing other development goals. The United Nations Millennium Development Goals now incorporate a target of universal access to sexual and reproductive health within the goal of improving maternal health, but combating HIV remains a separate project with malaria and tuberculosis. We present a brief history of key decisions made by WHO, other United Nations’ agencies, the United Nations Millennium Project and major donors that have led to the separation of HIV/AIDS from its logical programmatic base in sexual and reproductive health and rights. This fragmentation does a disservice to the achievement of both sets of goals and objectives. In urging a return to the original ICPD construct as a framework for action, we call for renewed leadership commitment, investment in health systems to deliver comprehensive sexual and reproductive health services, including HIV/AIDS prevention and treatment, comprehensive youth programmes, streamlined country strategies and donor support. All investments in research, policies and programmes should build systematically on the natural synergies inherent in the ICPD model to maximize their effectiveness and efficiency and to strengthen the capacity of health systems to deliver universally accessible sexual and reproductive health information and services. PMID:20072769
Smith, Malcolm K; Stepanov, Nikola
Abstract School-Based Youth Health Nurses (SBYHNs) work in Queensland high schools, providing sexual and reproductive health care/advice (amongst other things) to adolescents. SBYHNs are often responsible for referring high school students to other health care practitioners or external health services/community agencies. One of the difficulties faced in this context is how to assess the issue of capacity in terms of the adolescent's ability to provide consent to his or her own health care without parental involvement. This is important because it enables SBYHNs to maintain confidentiality with adolescents, which encourages adolescents to obtain sexual health advice. In this paper we outline the key legal principles relevant to nurses working in this field. We provide some practical examples of issues faced by SBYHNs and consider how the issue of Gillick competency is relevant to these examples. We demonstrate that the law seeks to prioritise the concept of confidentiality and aims to avoid exposing adolescents to harm that may result from unsafe sexual practices. Importantly, the issues discussed in this paper are relevant to nurses working within this field in all Australian jurisdictions.
Smith, Malcolm K; Stepanov, Nikola
Abstract School-Based Youth Health Nurses (SBYHNs) work in Queensland high schools, providing sexual and reproductive health care/advice (amongst other things) to adolescents. SBYHNs are often responsible for referring high school students to other health care practitioners or external health services/community agencies. One of the difficulties faced in this context is how to assess the issue of capacity in terms of the adolescent's ability to provide consent to his or her own health care without parental involvement. This is important because it enables SBYHNs to maintain confidentiality with adolescents, which encourages adolescents to obtain sexual health advice. In this paper we outline the key legal principles relevant to nurses working in this field. We provide some practical examples of issues faced by SBYHNs and consider how the issue of Gillick competency is relevant to these examples. We demonstrate that the law seeks to prioritise the concept of confidentiality and aims to avoid exposing adolescents to harm that may result from unsafe sexual practices. Importantly, the issues discussed in this paper are relevant to nurses working within this field in all Australian jurisdictions.
Sauer, Mark V
Advanced age is a risk factor for female infertility, pregnancy loss, fetal anomalies, stillbirth, and obstetric complications. These concerns are based on centuries-old observations, yet women are delaying childbearing to pursue educational and career goals in greater numbers than ever before. As a result, reproductive medicine specialists are treating more patients with age-related infertility and recurrent pregnancy loss, while obstetricians are faced with managing pregnancies often complicated by both age and comorbidities. The media portrayal of a youthful but older woman, able to schedule her reproductive needs and balance family and job, has fueled the myth that "you can have it all," rarely characterizing the perils inherent to advanced-age reproduction. Reproductive medicine specialists and obstetrician/gynecologists should promote more realistic views of the evidence-based realities of advanced maternal age pregnancy, including its high-risk nature and often compromised outcomes. Doctors should also actively educate both patients and the public that there is a real danger of childlessness if individuals choose to delay reproduction.
Cabal, Luisa; Olaya, Monica Arango; Robledo, Valentina Montoya
Conscientious Objection or conscientious refusal (CO) in access to reproductive health care is at the center of current legal debates worldwide. In countries such as the US and the UK, constitutional dilemmas surrounding CO in the context of reproductive health services reveal inadequate policy frameworks for balancing CO rights with women's rights to access contraception and abortion. The Colombian Constitutional Court's holistic jurisprudence regarding CO standards has applied international human rights norms so as to not only protect women's reproductive rights as fundamental rights, but to also introduce clear limits for the exercise of CO in health care settings. This paper reviews Latin American lines of regulation in Argentina, Uruguay, and Mexico City to argue that the Colombian Court's jurisprudence offers a strong guidance for future comprehensive policy approaches that aim to effectively balance tensions between CO and women's reproductive rights.
Ranasinghe, Shamika; Sjaarda, Lindsey A.; Mumford, Sunni L.
An evolving body of evidence supports that cadmium, a non-essential heavy metal, may be associated with multiple adverse women’s reproductive health outcomes. Our objective was to conduct a systematic review of epidemiologic studies that evaluated cadmium exposure and the following reproductive health outcomes: puberty/menarche, fertility, time to pregnancy, pregnancy loss, preeclampsia, endometriosis, uterine leiomyoma, and menopause. Twenty-two studies were identified based upon our search criteria. Available evidence was inadequate to draw meaningful conclusions for most of the reproductive outcomes studied. The strongest evidence was for a possible association between cadmium and preeclampsia, which was limited to cross-sectional studies. Some evidence, although conflicting, was also observed for fertility related outcomes. This lack of evidence underscores the need for additional research on cadmium and women’s reproductive health outcomes. PMID:27453808
The Reproductive System [and] Instructor's Guide: The Reproductive System. Health Occupations Education Module. Instructional Materials in Anatomy and Physiology for Pennsylvania Health Occupations Programs.
National Evaluation Systems, Inc., Amherst, MA.
This module on the reproductive system is one of 17 modules designed for individualized instruction in health occupations education programs at both the secondary and postsecondary levels. It is part of an eight-unit miniseries on anatomy and physiology within the series of 17 modules. Following a preface which explains to the student how to use…
Freedman, L P
Recent debates about the "politicization" of public health obscure the ways in which epidemiological concepts of risk are routinely used in the legal and political systems to apportion blame and responsibility for poor health. This article uses the example of reproductive health and rights to argue that new understandings of the connection between socioeconomic conditions and poor health will only generate change when they are reframed into political claims and pressed by social movements. In this connection, human rights language, principles, and practice hold great potential for the US reproductive rights movement, which has sometimes been constrained by the narrow scope of court rulings.
Mínguez-Alarcón, Lidia; Hauser, Russ; Gaskins, Audrey J.
Bisphenol A (BPA) is a ubiquitous environmental toxicant with endocrine-disrupting properties and suspected to affect human reproduction. Yet in humans, the studies exploring the effect of this BPA on male reproductive health including semen quality, reproductive hormones, and couple fecundity and fertility, have produced inconsistent results. The objective of this manuscript was to summarize the effects of male exposure to BPA on markers of testicular function and couple reproductive outcomes. Of the five studies on male BPA exposure and reproductive hormones, all found significant associations with at least one reproductive hormone; however no consistent relations were observed across studies. Similarly, five studies evaluated the relation between BPA and semen quality and while the majority reported negative associations with various parameters, there were few consistent trends across studies. Finally, the three studies which have examined male urinary BPA levels and couple reproductive outcomes did not find associations, with the exception being a link with lower secondary sex ratio (or greater female excess). Overall, while the literature on this topic is growing, the evidence supporting a link between male BPA exposure and male reproductive health remains limited and inconclusive. Reasons for the discrepancies in results could include, but are not limited to, differences in: study populations (e.g. fertile vs. subfertile men), BPA exposure levels (occupationally exposed vs. non-occupationally exposed), study procedures used to collect and measure urinary BPA (e.g. using one urine sample to characterize exposure vs. multiple samples), sample sizes, and study design (e.g. cross-sectional vs. prospective). Based on the available evidence, there is insufficient evidence to conclude that exposure to BPA, at low to moderate levels, has a negative effect on reproductive outcomes in men. Clearly, further studies are needed to further clarify the role of this
Meingast, Marci; Roosta, Tanya; Sastry, Shankar
The face of health care is changing as new technologies are being incorporated into the existing infrastructure. Electronic patient records and sensor networks for in-home patient monitoring are at the current forefront of new technologies. Paper-based patient records are being put in electronic format enabling patients to access their records via the Internet. Remote patient monitoring is becoming more feasible as specialized sensors can be placed inside homes. The combination of these technologies will improve the quality of health care by making it more personalized and reducing costs and medical errors. While there are benefits to technologies, associated privacy and security issues need to be analyzed to make these systems socially acceptable. In this paper we explore the privacy and security implications of these next-generation health care technologies. We describe existing methods for handling issues as well as discussing which issues need further consideration.
Ong, Homervergel G.; Kim, Young-Dong
The high maternal mortality in the Philippines in the past decades prompted intervention strategies to curb unwanted deaths of mothers and improve health and social conditions of women. Such introductions however have begun to challenge traditional reproductive health practices creating confusion among practitioners and incipient transitions in healthcare. Our aim in this study was to document the herbal therapies practiced by indigenous Ati Negrito women and discuss the implications of social and conventional healthcare intervention programs on reproductive healthcare traditions by conducting semistructured interviews. Fidelity Level index was used to determine culturally important plants (i.e., the most preferred). Review of related studies on most preferred plants and therapies was further carried out to provide information regarding their safety/efficacy (or otherwise). Determination of informants' traditional medicinal knowledge was done using Mann-Whitney U and Kruskal-Wallis tests. A total of 49 medicinal plants used in treating female reproductive health-related syndromes across four categories were recorded. Significant differences in traditional medicinal knowledge were recorded when informants were grouped according to age, education, and number of children. Issues discussed in this research could hopefully raise awareness on changes in healthcare practices in indigenous cultures and on medical safety especially when traditional and conventional medications interact. PMID:26345471
This paper is a reflection on some of the successess and challenges that followed in the aftermath of the International Conference on Population and Development (ICPD) Cairo, 1994, and the capacity of civil society and of donors to address them. It is written with two voices--from my experience as an NGO activist for sexual and reproductive rights since the early 1980s and my experience as a programme officer for a donor for the last 18 months. It calls for a focus on implementation of services within public health and education systems, the need to deepen the capacities of activists and build new leaders, and the value of alliances with other movements whose goals are also being challenged by macro-economic forces and fundamentalist movements. At national level, I suggest three major goals: monitoring public sector spending, strengthening public health system capacity for implementation, and advocacy and community organisation to enable shifts in public understanding of sexual and reproductive rights. Lastly, as regards funding, it calls for dialogue about funding issues between NGOs and donors, for donors to increase national capacity development in the global south and for all those committed to change in relation to sexual and reproductive health and rights to commit themselves for the long haul, given the slow pace of change.
Manski, Ruth; Grindlay, Kate; Burns, Bridgit; Holt, Kelsey; Grossman, Daniel
Servicewomen's reproductive health experiences during deployment are important given that the majority of women in the U.S. military are of reproductive age and that this population experiences a disproportionately high rate of unintended pregnancy. Few studies have explored women's reproductive health experiences and their perceived barriers and facilitators to health care access during deployment. From May 2011 to January 2012, we conducted 22 in-depth interviews with women in the U.S. military about their reproductive health experiences during deployment, including their access to health services. Participants identified a range of barriers to accessing medical care in deployment settings, including confidentiality concerns, lack of female providers, and health-seeking stigma, which were reported to disproportionately impact reproductive health access. Some participants experienced challenges obtaining contraceptive refills and specific contraceptive methods during deployment, and only a few participants received predeployment counseling on contraception, despite interest in both menstruation suppression and pregnancy prevention. These findings highlight several policy and practice changes that could be implemented to increase contraceptive access and reduce unintended pregnancy during deployment, including mandated screening for servicewomen's contraceptive needs before operational duty and at least annually, and increasing the number of female providers in deployed settings.
Okigbo, Chinelo C; Adegoke, Korede K; Olorunsaiye, Comfort Z
There is an urgent need to improve reproductive health (RH) in Nigeria - the most populous country in Africa. In 2015, Nigeria had the highest number of maternal deaths in the world. This study assessed the trends in select RH indicators in Nigeria over two decades. Data used were from Nigeria Demographic and Health Surveys (NDHS) conducted between 1990 and 2013. The NDHS uses a two-stage cluster sampling design to select nationally representative samples of reproductive-age women. The study sample ranged from 7620 to 38,948 women aged 15-49 across the five surveys. Trends in modern contraceptive prevalence rate, skilled antenatal care, skilled birth attendance, and adolescent birth were assessed. The results show increasing trends in modern contraceptive prevalence rate from 4% in 1990 to 11% in 2013 (p < .001); in skilled antenatal care from 57% in 1990 to 61% in 2013 (p < .001); and in skilled birth attendance from 31% in 1990 to 40% in 2013 (p < .001). The trend in adolescent birth decreased from 24% in 1990 to 17% in 2013 (p < .001). Marked disparities exist as rural, poor, and less educated women bear the greatest burden. Interventions should target the at-risk populations to improve their access and use of RH services.
New York Governor's Advisory Committee for Black Affairs, Albany.
An examination of the health status of blacks in each phase of the life cycle in New York State indicates a significant discrepancy between the health status of black and white New Yorkers, and a clear link between poverty and poor health. The following life stages were examined and key health issues were identified: (1) prenatal/newborn; (2)…
De Martinis, Massimo; Sirufo, Maria Maddalena; Ginaldi, Lia
Allergy reactions are the most common immunological diseases and represent one of the most widespread and fast growing chronic human health problems among people over 15 years of age in developed countries. As populations get older worldwide, allergy manifestations in aged persons will occur more often in the future. To date, there has been much more studies on allergies in children than in adults. As the population ages, clinicians must be prepared to meet all the elderly's health care needs, including these new and emerging health issue. Allergic diseases represent an old/new emerging health issue. Because many common illnesses masquerade as atopic disease, the differential diagnosis of suspected allergic diseases becomes more expanded in an aging population. Research in the field needs to focus on both human and animal model systems to investigate the impact of the aging process on the immunologic pathways underpinning allergy and its different facets.
Connor, Thomas H.; Lawson, Christina C.; Polovich, Martha; McDiarmid, Melissa A.
Objectives Antineoplastic drugs are known reproductive and developmental toxicants. Our objective was to review the existing literature of reproductive health risks to workers who handle antineoplastic drugs. Methods A structured literature review of 18 peer-reviewed, English language publications of occupational exposure and reproductive outcomes was performed. Results While effect sizes varied with study size and population, occupational exposure to antineoplastic drugs appears to raise the risk of both congenital malformations and miscarriage. Studies of infertility and time-to-pregnancy also suggested an increased risk for sub-fertility. Conclusions Antineoplastic drugs are highly toxic in patients receiving treatment and adverse reproductive effects have been well documented in these patients. Healthcare workers with chronic, low level occupational exposure to these drugs also appear to have an increased risk of adverse reproductive outcomes. Additional precautions to prevent exposure should be considered. PMID:25153300
Background With health sector reform in Vietnam moving towards greater pluralism, commune health stations (CHSs) have been subject to growing competition from private health services and increasing numbers of patients bypassing CHSs for higher-level health facilities. This study describes the pattern of reproductive health (RH) and family planning (FP) service utilization among women at CHSs and other health facilities, and explores socio-demographic determinants of RH service utilization at the CHS level. Methods This study was based on a cross-sectional survey conducted in Thua Thien Hue and Vinh Long provinces, using a multi-stage cluster sampling technique. Questionnaire-based interviews with 978 ever-married women at reproductive age provided data on socio-demographic characteristics, current use of FP methods, history of RH service use, and the health facility attended for their most recent services. Multiple logistic regression analyses were used to identify socio-demographic determinants of their use of CHS RH services. Results Eighty nine percent of ever-married women reported current use of birth control with 49% choosing intra-uterine device (IUD). Eighty nine percent of pregnant women attended facility-based antenatal care (ANC) with 62% having at least 3 check-ups during their latest pregnancy. Ninety one percent of mothers had their last delivery in a health facility. Seventy-one percent of respondents used CHS for IUD insertion, 55% for antenatal check-ups, and 77% gynecological examination. District and provincial/central hospitals dominated the provision of delivery service, used by 57% of mothers for their latest delivery. The percentage of women opting for private ANC services was reported at 35%, though the use of private delivery services was low (11%). Women who were farmers, earning a lower income, having more than 2 children, and living in a rural area were more likely than others to use ANC, delivery, and/or gynecological check-up services
Gold, Melanie A.; Chiappetta, Laurel; Young, Amanda J.; Zuckoff, Allan; DiClemente, Carlo C.
Purpose: To assess girls' reproductive educational choices, satisfaction with choice, and relationship between demographics, module choice, and satisfaction. Methods: We recruited 286 girls, aged 13 to 21 years, from a hospital-based adolescent clinic, from advertisements, and by word of mouth. At enrollment, participants completed a 60-minute…
In Timor-Leste, high fertility, high maternal mortality and low levels of contraceptive prevalence demonstrate the importance of exploring perceptions, policies and practices around reproductive health and rights. This paper explores the influence of the Catholic Church on reproductive decision-making at different levels of policy and practice. Utilising a feminist qualitative research methodology, in-depth interviews were conducted with a range of participants including nuns and priests, Timorese women and men of different ages and backgrounds and local and national stakeholders working in reproductive health and women's rights. Findings reveal that the Church is reported to play a significant role in reproductive health and rights decision-making at all levels of society, from policy-making to the reproductive decisions made by individual Timorese women and men. Nevertheless, the translation of Church teachings into practice, particularly by nuns, priests and Timorese men and women, reveal a range of attitudes and opinions; some that support and others that contest official Catholic doctrine. In light of the significant influence of the Timorese Catholic Church on policy and practice at many levels of society, there is a need to prioritise the development of rights-based strategies to improve reproductive health services in Timor-Leste.
Roeser, Robert W.
Introduces issue of collected articles that work towards providing an integration of and across-fertilization between education- and mental health-oriented theory, research, and school-based practice. The articles seek to show how academic and social-emotional assets and problems are interrelated and how schools have a role in their development…
Sexual and reproductive health services in Iran are influenced by population policies. Willingness of Iranian policy makers to control the population's growth rate resulted in the provision of countrywide family planning services and contraceptives from 1990 to 2013. Now policy makers favour population growth because of a statistically significant decline in the fertility rate and ageing of the population. New population policies contain incentives for higher fertility and limitations on family planning services. Some elements of these policies contradict standards of international human rights treaties including prohibition against retrogressive measures and limitations on sexual and reproductive health services. These policies may jeopardize individual and public health. Iran should immediately revoke these laws and policies and progressively improve people's enjoyment of their right to sexual and reproductive health. The country's population policies should focus on encouraging people to have higher fertility by providing financial and social support to parents and future children.
Lee, Mary Y.; Albright, Susan A.; Alkasab, Tarik; Damassa, David A.; Wang, Paul J.; Eaton, Elizabeth K.
Describes a seven-year experience with developing the Tufts Health Sciences Database, a database-driven information management system that combines the strengths of a digital library, content delivery tools, and curriculum management. Identifies major effects on teaching and learning. Also addresses issues of faculty development, copyright and…
Summarizes principal features of 6 bills on health care reform introduced in the 103rd Congress as they relate to children. Proposals are compared on 11 major issues, highlighting the degree to which each bill would achieve universal coverage, access to care, equity of treatment, and quality of comprehensive care. (SLD)
Andrews, Jana; McLean, Patricia
This resource kit provides information intended to assist Australian disability liaison officers (DLO) and others who work with college students with psychiatric disabilities to understand the effects of mental health issues on learning in the context of post-secondary education. The guide suggests a range of compensatory strategies that aim to…
Bower, Wilma; And Others
Some children in American schools have known and unknown communicable diseases, including herpes, cytomegalovirus, AIDS, mononucleosis, pinworms, and hepatitis. This article examines major public health issues, school responsibility, preventative measures (like basic hygiene), and the need for more effective community education programs. A disease…
It is clear from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report published last month that hospitals are failing to integrate physical and mental healthcare. As a result, patients with mental health issues are receiving poor care and nurses are too often failing to refer such patients to the appropriate specialist support.
This paper focuses on widening participation and accessibility in relation to mental health issues and undergraduate psychology students. Sections 1 and 2 set the context and outline the scope and aims of this paper. Section 3 presents evidence of the student experience from the Improving Provisions for Disabled Psychology Students (IPDPS)…
Crockett, Cailin; Cooper, Bergen
Despite their demographic significance and the lifetime impact of gender disparities on their health and rights, women considered older than reproductive age are excluded from most investments in global public health. While development policies linking human rights with access to sexual and reproductive healthcare have yielded progress towards improving the status of women and girls, older women have not benefited from these initiatives. Yet as women grow older, they experience a range of health conditions rooted in their reproductive biology - from ageing with fistula, to cervical and breast cancers. Current approaches to global women's health ignore these serious conditions, harming older women through the perpetuation of gender norms that construe women's health through a narrow reproductive lens. Meanwhile, older women are generally absent from global ageing discourse, which lacks a gender perspective, creating a dual invisibility as the field of global women's health presumes ageing women are accounted for. Reclaiming the sexual rights framework suggested by the International Conference on Population and Development and the Beijing Platform for Action, we call for the revision of global health policies to incorporate a life course approach to women's health as a matter of human rights.
Trieu, Sang Leng; Marshak, Helen Hopp; Bratton, Sally I.
Analyzed were the sexual and reproductive health behaviors of Asian Pacific Islander (API) California community college students who took the National College Health Assessment (NCHA) survey. This was done to identify characteristics related to sexual behavior and choice of birth control and examine the association between condom use and history…
DeMairo, Pauline; Dischell, Jackie; Jouthe, Sorahya A.; Horner, Andrea
The Teen Outreach Reproductive CHallenge (TORCH) is a peer education program that provides information on various topics relevant to adolescent sexual health to a diverse audience, ranging from teens to health care providers. This information is disseminated through various projects by a group of New York City high-school students who are…
Poljski, Carolyn; Quiazon, Regina; Tran, Chau
Drawing on the research and advocacy work being conducted by the Multicultural Centre for Women's Health (MCWH), a national community-based organization in Victoria, Australia, the paper analyzes female international students' experiences with accessing sexual and reproductive health information and services. Accessibility of sexual and…
Mouhanna, Farah; DeJong, Jocelyn; Afifi, Rima; Asmar, Khalil; Nazha, Bassel; Zurayk, Huda
Reproductive health education (RHE) programmes in schools are a well-recognised means of helping young people make informed decisions relating to their sexual health and well-being. Very little research however has investigated attitudes towards such programmes among students in the Arab world. A national HIV education curriculum was developed in…
Gokhale, Runa H; Bradley, Heather; Weiser, John
Advances in antiretroviral therapy (ART) and reproductive technologies have made transmission of HIV to partners and infants almost completely preventable. Comprehensive reproductive health counseling (CRHC) is an important component of care for women living with HIV, but few women report discussing reproductive health with an HIV care provider. We surveyed a probability sample of U.S. HIV care providers during 2013-2014. Of 2023 eligible providers, 1234 responded (64% adjusted provider response rate). We estimated the percentage delivering CRHC to their female patients. CRHC was defined as delivering each of five components of reproductive health care to most or all female patients. We assessed associations between provider characteristics and delivering CRHC using chi-squared tests and multivariable logistic regression. Of all providers, 49% (95% confidence interval [CI], 42-55) reported delivering all components of CRHC: 71% assessed reproductive intentions of reproductive-aged women, 78% explained perinatal transmission risk, 87% discussed ART for preventing perinatal transmission, 76% provided contraception as appropriate, and 64% provided referrals for preconception care. Among providers who offered primary care (83% of sample), 52% (CI: 44-60) delivered CRHC compared to 33% (CI: 22-44) of providers who did not offer primary care (P = .01). More female providers (46% of sample) compared to male providers delivered CRHC (57% [CI: 48-65] vs. 40% [CI: 31-50], P < .01). Delivery of CRHC by providers did not differ by patient caseload. After adjusting for gender, years of HIV experience, and patient caseload, providing primary care to HIV-infected patients remained associated with delivering CRHC (adjusted prevalence ratio [aPR] 1.48, 95% CI 1.02-2.16). Provider delivery of CRHC is not consistent with current guidelines that recommend discussing reproductive health with all reproductive-aged women who are living with HIV, even among providers offering
Kumar, Pawan; Inder, Deep; Sharma, Nandini
The human body is a wonderful machine. The future of child birth in the form of test tube babies, surrogate motherhood through new reproductive and cloning technology will introduce undreamt of possibilities in the sexual arena. Surrogacy is a method of assisted reproduction whereby a woman agrees to become pregnant for the purpose of gestating and giving birth to a child for others to raise. In some jurisdictions the possibility of surrogacy has been allowed and the intended parents may be recognized as the legal parents from birth. Commercial surrogacy, or "Womb for rent", is a growing business in India. In our rapidly globalizing world, the growth of reproductive tourism is a fairly recent phenomenon. Surrogacy business is exploiting poor women in country like India already having with an alarmingly high maternal death rate. This paper talks about paternity issues and women's right to health in context of surrogacy. Government must seriously consider enacting a law to regulate surrogacy in India in order to protect and guide couples going in for such an option. Without a foolproof legal framework, patients will invariably be misled and the surrogates exploited.
Hanoch, Yaniv; Finkelstein, Eric Andrew
Introduces the special issue of Health Psychology, entitled Health Psychology Meets Behavioral Economics. Psychologists have long been interested in understanding the processes that underlie health behaviors and, based on health behavior models that they have developed, have devised a spectrum of effective prevention and treatment programs. More recently, behavioral economists have also provided evidence of effective behavior change strategies through nonprice mechanisms in a variety of contexts, including smoking cessation, weight loss, and illicit drug use. Yet, although all are addressing similar issues, surprisingly little cross-fertilization has taken place between traditional economists, behavioral economists, and psychologists. This special issue is rooted in the assumption that collaboration between economists and psychologists can promote the development of new methodologies and encourage exploration of novel solutions to enduring health problems. The hope is that readers will be intrigued and inspired by the methodologies used in the different articles and will explore whether they might be applicable to the problems they are addressing. Collaborative efforts, although challenging and at times risky, are a promising way to produce more innovative studies, results, and interventions.
Pepe, S P; Keith, C L
The 1974 amendments to the Labor Management Relations Act have created new problems of statutory interpretation in the rapidly evolving area of health care labor law. By including nonprofit hospitals under the auspices of the Act, the amendments have opened up a new area for unionization and have given rise to questions concerning the types of bargaining units that are appropriate in health care facilities. In the following article, the authors discuss these questions and other current issues in health care labor relations law. The issues include the determination of relevant bargaining units, the status of state nursing associations as labor organizations, and the ten-day strike notice requirement of the Labor Management Relations Act.
Suzin, Daphne; McIlvenna, Susanne
As more and more people are successfully treated for and live longer with cancer, greater attention is being directed toward the survivorship needs of this population. Women treated for cancer often experience issues related to sexual health and intimacy, which are frequently cited as areas of concern, even among long-term survivors. Unfortunately, data suggest that providers infrequently discuss these issues. We reviewed a contemporary understanding of sexual health of women and the impact of treatment on both sexual function and intimacy. We also provide a review of the diagnosis using the newest classification put forth by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, and potential treatments, including both endocrine and nonendocrine treatments that the general oncologist may be asked about when discussing sexual health with his or her patients. PMID:24396051
Frank, Lauren B
The purpose of this study is to advance theorizing about how small groups understand health issues through the use of social network analysis. To achieve this goal, an adapted cognitive social structure examines group social norms around a specific health issue, H1N1 flu prevention. As predicted, individual's attitudes, self-efficacy, and perceived social norms were each positively associated with behavioral intentions for at least one of the H1N1 health behaviors studied. Moreover, collective norms of the whole group were also associated with behavioral intentions, even after controlling for how individual group members perceive those norms. For members of work groups in which pairs were perceived to agree in their support for H1N1 vaccination, the effect of individually perceived group norms on behavioral intentions was stronger than for groups with less agreement.
Frank, Lauren B.
The purpose of this study is to advance theorizing about how small groups understand health issues through the use of social network analysis. To achieve this goal, an adapted cognitive social structure examines group social norms around a specific health issue, H1N1 flu prevention. As predicted, individual’s attitudes, self-efficacy, and perceived social norms were each positively associated with behavioral intentions for at least one of the H1N1 health behaviors studied. Moreover, collective norms of the whole group were also associated with behavioral intentions, even after controlling for how individual group members perceive those norms. For members of work groups in which pairs were perceived to agree in their support for H1N1 vaccination, the effect of individually perceived group norms on behavioral intentions was stronger than for groups with less agreement. PMID:26389934
Sánchez, John Paul; Sola, Orlando; Ramallo, Jorge; Sánchez, Nelson Felix; Dominguez, Kenneth; Romero-Leggott, Valerie
Hispanics represent the fastest growing ethnic segment of the lesbian, gay, bisexual, and transgender (LGBT) community in the United States and are disproportionately burdened by LGBT-related health issues and limited political support from Hispanic medical organizations. Recently, the Latino Medical Student Association, the National Hispanic Medical Association, and the Hispanic Serving Health Professions Schools, representing over 60,000 Hispanic students and providers and 35 institutions, collaborated to support a resolution opposing discrimination based on sexual orientation or gender identity and recognizing the obstacles encountered by LGBTQ Hispanics. The resolution provides an important framework for organizational members and leaders to address LGBT health issues and serve to support a more positive sociopolitical climate for the Hispanic LGBT community nationally and internationally.
Li, Zheng; Hogan, Karen A.; Cai, Christine; Rieth, Susan
Background: In support of the Integrated Risk Information System (IRIS), the U.S. Environmental Protection Agency (EPA) has evaluated the human health hazards of biphenyl exposure. Objectives: We review key findings and scientific issues regarding expected human health effects of biphenyl. Methods: Scientific literature from 1926 through September 2012 was critically evaluated to identify potential human health hazards associated with biphenyl exposure. Key issues related to the carcinogenicity and noncancer health hazards of biphenyl were examined based on evidence from experimental animal bioassays and mechanistic studies. Discussion: Systematic consideration of experimental animal studies of oral biphenyl exposure took into account the variety of study designs (e.g., study sizes, exposure levels, and exposure durations) to reconcile differing reported results. The available mechanistic and toxicokinetic evidence supports the hypothesis that male rat urinary bladder tumors arise through urinary bladder calculi formation but is insufficient to hypothesize a mode of action for liver tumors in female mice. Biphenyl and its metabolites may induce genetic damage, but a role for genotoxicity in biphenyl-induced carcinogenicity has not been established. Conclusions: The available health effects data for biphenyl provides suggestive evidence for carcinogenicity in humans, based on increased incidences of male rat urinary bladder tumors at high exposure levels and on female mouse liver tumors. Kidney toxicity is also a potential human health hazard of biphenyl exposure. Citation: Li Z, Hogan KA, Cai C, Rieth S. 2016. Human health effects of biphenyl: key findings and scientific issues. Environ Health Perspect 124:703–712; http://dx.doi.org/10.1289/ehp.1509730 PMID:26529796
Littleton, Fiona Kisby
Despite an 'epidemic' of delayed childbirth in England and Wales beyond a woman's optimally fertile years, research shows that young adults are unaware of or misunderstand the risks regarding starting or extending families that such behaviour entails. Currently, sex education syllabi in British schools neglect these issues, rendering school leavers ignorant of them.These curricula cannot be improved until more is known about adolescents' knowledge of relevant topics. In the light of this, this article describes exploratory research on how teenage girls in one English school think about the reproductive lifespan. Going beyond recent 'scientific' investigations which have mostly only tested the extent of ignorance of young adults, this qualitative enquiry used theories of the life course and emerging adulthood to analyse data gathered in interviews. It sought to understand not only what girls know, but how they apply their knowledge in relation to their assumptions about aging, motherhood, pregnancy, parenting and employment. One finding is highlighted here: that whilst "correct" knowledge about the reproductive lifespan does appear to be held by teenage girls, the ability to apply that knowledge and connect the socio-cultural with the biological domain, may not always be in place. This is relevant for curriculum developers aiming to prepare future citizens to take full control of their reproductive health, and policy makers responsible for ensuring an appropriate public health message about these concerns is available after formal schooling ends.
Lipson, Juliene G.; Meleis, Afaf I.
Relationships between Middle Eastern patients and Western health care professionals are often troubled by mutual misunderstanding of culturally influenced values and communication styles. Although Middle Easterners vary ethnically, they do share a core of common values and behavior that include the importance of affiliation and family, time and space orientations, interactional style and attitudes toward health and illness. Problems in providing health care involve obtaining adequate information, “demanding behavior” by a patient's family, conflicting beliefs about planning ahead and differing patterns of communicating grave diagnoses or “bad news.” There are guidelines that will provide an understanding of the cultural characteristics of Middle Easterners and, therefore, will improve rather than impede their health care. A personal approach and continuity of care by the same health care professional help to bridge the gap between Middle Eastern cultures and Western medical culture. In addition, periodic use of cultural interpreters helps ameliorate the intensity of some cultural issues. PMID:6364575
Azevedo, Suzanna M; Vartanian, Lenny R
Obesity is a major public health concern worldwide. Because individual-level interventions have been unsuccessful at curbing obesity rates, there is an emphasis on public health approaches. In addition to testing the effectiveness of any public health interventions, it is important to consider the ethical implications of these interventions in order to protect the public's rights and promote overall well-being. In this paper, we review public health approaches to obesity in three broad domains (changes to the socio-communicative environment, changes to the economic environment, and changes to the physical environment/access) and consider the potential ethical issues that arise in each of those domains. We suggest that interventions that target the physical environment/access (making it easier for people to engage in healthy behaviors), that target the entire population (rather than just individuals with obesity), and that focus on health behaviors (rather than on weight) have the least potential for ethical concerns.
Foster, Angel M; Wynn, Lisa; Rouhana, Aida; Polis, Chelsea; Trussell, James
Emergency contraception (EC) has the potential to reduce significantly the incidence of unintended pregnancy worldwide. In May 2003, the first Arabic-language web site dedicated to disseminating information about and increasing awareness of EC was launched. This paper examines patterns of web site use and user profiles over a 19-month period. Analysis of use shows that the Arabic web site users are interested in different aspects of EC than the English web site users, suggesting the importance of creating culturally specific content when adapting and translating health education materials. Arabic web site users demonstrate significant interest in general reproductive health issues not specific to EC, suggesting a need for greater availability of Arabic-language health education resources through the Internet.
Petitet, Pascale Hancart
The processes involved in nosocomial transmission of HIV, HBV, and HCV nosocomial transmission have not been studied at a global level; little is known about them or about the underlying social and cultural logic that contributes to this transmission. Hospital hygiene has mainly been studied from a biological perspective until now. However, hospital hygiene is shaped by norms and sociocultural representations, and the increase or limitation of disease transmission always takes place within social relations. We need to analyse the practices related to hygiene from a cultural perspective, especially since norms are interpreted at the local level according to social and symbolic logic. Our paper aims to investigate these issues in the context of reproductive health care practices in Cambodia. We describe various perceptions, attitudes and roles of both medical and non-medical caregivers and show how they determine practices, as well as how sanitary, social and institutional contexts shape practices. Since 1995, public health institutions have provided contraceptive methods (condoms, oral or injectable contraceptives, contraceptive implants, intrauterine devices, and emergency contraception). Except for the free distribution of condoms, particularly by NGOs as part of HIV prevention programs, access to contraception is not free. Private clinics and local and international NGOs provide many of these services. Many women in both urban and rural areas seek reproductive health care in the informal sector, from caregivers who may or may not be trained. We thus wonder if these practices, as implemented in the formal and informal care sectors, create a risk for the transmission of HIV, HVB, and HVC. We analyse those issues in considering especially the injection of Depo-Provera, insertion of intrauterine devices, vaginal cleaning practices, and surgical abortion. This investigation of the sociocultural dimension of hygiene in the field of reproductive health care underlines
Larrañaga, Isabel; Martín, Unai; Bacigalupe, Amaia
Sexual and reproductive health (SRH) is protected by the public authorities to ensure that people enjoy a free, satisfying, and safe sexual life. Despite the approval of the National Sexual and Reproductive Health Strategy in 2011, the progress achieved may be jeopardized by recent proposals for legislative changes affecting this area (abortion Law and 16/2012 Law) and by the impact of the current economic crisis. This article aims to describe the current situation of sexual and reproductive health in the Spanish population and to identify the potential impact of the economic crisis. To this end, we used the following information sources: the National Sexual Health Survey, the DAPHNE surveys, births and fetal deaths statistics from the Spanish National Institute of Statistics, the Registry of Voluntary Pregnancy Interruptions, reports from the National Epidemiology Center, and the National AIDS Registry. Sexual health and the availability of information are rated as good by the Spanish population. Among young people, schools and health services have become less important as information sources and the internet has become more important. Since the beginning of the crisis, contraceptive use and fertility have declined and maternity has been delayed. The economic crisis seems to have affected some indicators of sexual and reproductive health. However, the potential effects on other indicators should continue to be monitored because insufficient time may have passed for accurate determination of the full effect of the crisis.
Topatan, Serap; Demirci, Nurdan
Our research, partly experimental and partly prospective, was conducted for the purpose of evaluating the efficiency of reproductive health education given to adolescents during the postpartum period. The study comprised with 120 adolescents aged 15 to 19 (60 experimental group, 60 control group). Follow-up was conducted every 3 months for a total of 12 months, and the study concluded with 55 individuals from the experimental group and 46 individuals from the control group having participated fully, for the full 12 months. At the end of the research, it was found that the reproductive health knowledge of the experimental (103.10 ± 11.43) and control (99.15 ± 9.53) groups were similar before education. A statistically significant difference was also found between the total points for the scale determining the reproductive health of the experimental and control groups before and after education (P < .001). The socio-demographic variables affecting the total points for the scale determining the reproductive health-protective behavior of women were evaluated by multiple regression analysis; the most effective variables were found to be age and educational status. A statistically significant difference was also found between the total points for the family planning behavior scale of the experimental and control groups before and after education (P < .001). From this, it was understood that reproductive health education given during the postpartum and follow-up periods has a positive effect on adolescents' developing reproductive health behaviors and on creating knowledge and awareness related to family planning behavior. But there needs to be follow-up and supporting specific for adolescents in the current health system.
Nardi, Elizabeth A; Lentz, Lisa Korin; Winckworth-Prejsnar, Katherine; Abernethy, Amy P; Carlson, Robert W
When used effectively, health information technology (HIT) can transform clinical care and contribute to new research discoveries. Despite advances in HIT and increased electronic health record adoption, many challenges to optimal use, interoperability, and data sharing exist. Data standardization across systems is limited, and scanned medical note documents result in unstructured data that make reporting on quality measures for reimbursement burdensome. Different policies and initiatives, including the Health Information Technology for Economic and Clinical Health Act, the Medicare Access and CHIP Reauthorization Act, and the National Cancer Moonshot initiative, among others, all recognize the impact that HIT can have on cancer care. Given the growing role HIT plays in health care, it is vital to have effective and efficient HIT systems that can exchange information, collect credible data that is analyzable at the point of care, and improves the patient-provider relationship. In June 2016, NCCN hosted the Emerging Issues and Opportunities in Health Information Technology Policy Summit. The summit addressed challenges, issues, and opportunities in HIT as they relate to cancer care. Keynote presentations and panelists discussed moving beyond Meaningful Use, HIT readiness to support and report on quality care, the role of HIT in precision medicine, the role of HIT in the National Cancer Moonshot initiative, and leveraging HIT to improve quality of clinical care.
Women's health is currently shaped by the confluence of two important policy trends - the evolution of health system reform policies and from the early 1990s onwards, a strong articulation of a human rights-based approach to health that has emphasised laws and policies to advance gender equality and sexual and reproductive health and rights (SRHR). The drive for sexual and reproductive rights represents an inclusive trend towards human rights to health that goes beyond the right to health services, directing attention to girls' and women's rights to bodily autonomy, integrity and choice in relation to sexuality and reproduction. Such an expanded concept of the right to health is essential if laws, policies and programmes are to respect, protect and fulfil the health of girls and women. However, this expanded understanding has been ghettoised from the more mainstream debates on the right to health and was only partially included in the Millennium Development Goals. The paper argues in favour of a twofold approach in placing SRHR effectively in the context of the post-2015 development agenda: first, firmly ground it in an inclusive approach to the right to health; and second, drawing on two decades of national-level implementation, propose a forward-looking agenda focusing on quality, equality and accountability in policies and in programmes. This can build on good practice while addressing critical challenges central to the development framework itself.
Clauss, C A; Berzon, M; Bertin, J
In a major decision handed down last term (International Union [UAW] versus Johnson Controls, Inc.), the Supreme Court ruled that employment practices excluding fertile or pregnant women from the workplace because of alleged concerns for fetal health constitute illegal sex discrimination. We analyze the three opinions in the case and explain why the decision was an essential first step to promoting reproductive and developmental health in the workplace. Continued progress toward eliminating or reducing reproductive occupational risks will require comprehensive legal strategies involving private lawsuits, governmental regulation and enforcement actions, and new legislation designed to preserve the existing rights of workers and to obtain new and additional protections. Finally, we caution that, in designing such strategies, it will be important to avoid solutions that either shift responsibility for reproductive health to workers, rather than to employers, or that undermine other important legal rights. PMID:8243393
This article begins by reviewing selected past approaches to estimating the prevalence of a range of morbidities through the use of household or community-based interview surveys in developed and developing countries. Subsequently, it reviews epidemiological studies that have used a range of methods to estimate the prevalence of reproductive morbidities. A detailed review of recent community or hospital based health interview validation studies that compare self-reported, clinical and laboratory measures is presented. Studies from Bangladesh, Bolivia, China, Egypt, India, Indonesia, Nigeria, Philippines and Turkey provide empirical evidence that self-reported morbidity and observed morbidity measure different phenomena and therefore different aspects of reproductive health and illness. Rather than estimating the prevalence of morbidity, interview-based surveys may provide useful information about the disability or burden associated with reproductive health and illness. PMID:10859858
Alvarez, Maria do Carmo Avamilano; Cuenca, Angela Maria Belloni; Noronha, Daisy Pires; Schor, Néia
Virtual libraries have been implemented in an attempt to organize scientific information found in the Internet, including the Biblioteca Virtual de Saúde Reprodutiva (BVSR), or Virtual Library on Reproductive Health. The aim is to provide quality information to researchers in the reproductive health field. The current study evaluates the use of the BVSR, emphasizing the users' expectations, difficulties, and suggestions. The study adopted a qualitative methodology. The focus group technique was applied to Internet chat groups through which reproductive health researchers communicated. Users expressed their expectations regarding information, highlighting the lack of time and the need to quickly obtain precise data. Use of virtual libraries for research increases where there is more trust in the institutions responsible for maintaining them. Researchers suggested the following: greater dissemination of the BVSR, publication of an electronic newsletter, and creation of a communications channel between the BVSR and users in order to foster intelligent collective communication.
Chiu, Weihsueh A.; Caldwell, Jane C.; Keshava, Nagalakshmi; Scott, Cheryl Siegel
Trichloroethylene (TCE) is a common environmental contaminant at hazardous waste sites and in ambient and indoor air. Assessing the human health risks of TCE is challenging because of its inherently complex metabolism and toxicity and the widely varying perspectives on a number of critical scientific issues. Because of this complexity, the U.S. Environmental Protection Agency (EPA) drew upon scientific input and expertise from a wide range of groups and individuals in developing its 2001 draft health risk assessment of TCE. This scientific outreach, which was aimed at engaging a diversity of perspectives rather than developing consensus, culminated in 2000 with 16 state-of-the-science articles published together as an Environmental Health Perspectives supplement. Since that time, a substantial amount of new scientific research has been published that is relevant to assessing TCE health risks. Moreover, a number of difficult or controversial scientific issues remain unresolved and are the subject of a scientific consultation with the National Academy of Sciences coordinated by the White House Office of Science and Technology Policy and co-sponsored by a number of federal agencies, including the U.S. EPA. The articles included in this mini-monograph provide a scientific update on the most prominent of these issues: the pharmacokinetics of TCE and its metabolites, mode(s) of action and effects of TCE metabolites, the role of peroxisome proliferator–activated receptor in TCE toxicity, and TCE cancer epidemiology. PMID:16966103
Sundari Ravindran, T K; Fonn, Sharon
A social franchise in health is a network of for-profit private health practitioners linked through contracts to provide socially beneficial services under a common brand. The early 21st century has seen considerable donor enthusiasm for promoting social franchises for the provision of reproductive health services. Based on a compendium of descriptive information on 45 clinical social franchises, located in 27 countries of Africa, Asia and Latin America, this paper examines their contribution to universal access to comprehensive reproductive health services. It finds that these franchises have not widened the range of reproductive health services, but have mainly focused on contraceptive services, and to a lesser extent, maternal health care and abortion. In many instances, coverage had not been extended to new areas. Measures taken to ensure sustainability ran counter to the objective of access for low-income groups. In almost two-thirds of the franchises, the full cost of all services had to be paid out of pocket and was unaffordable for low-income women. While standards and protocols for quality assurance were in place in all franchises, evidence on adherence to these was limited. Informal interviews with patients indicated satisfaction with services. However, factors such as difficulties in recruiting franchisees and significant attrition, franchisees' inability to attend training programmes, use of lay health workers to deliver services without support or supervision, and logistical problems with applying quality assurance tools, all raise concerns. The contribution of social franchises to universal access to reproductive health services appears to be uncertain. Continued investment in them for the provision of reproductive health services does not appear to be justified until and unless further evidence of their value is forthcoming.
Bhatti, Lubna Ishaq; Fikree, Fariyal F
To explore the contextual factors influencing health-seeking behavior of women in Karachi regarding reproductive tract infections, 18 women with reproductive tract infections from different clinics and community settings were identified and in-depth interviews were conducted. Physicians in our study diagnosed a woman to have lower reproductive tract infection if she complained of malodorous vaginal discharge with or without perineal itching; and to have pelvic inflammatory disease or upper reproductive tract infection if she had any two of the following complaints: malodorous vaginal discharge, menstrual irregularities, lower abdominal pain or dyspareunia. Women consulted a variety of healthcare providers in their pursuit for treatment, mainly allopathic doctors and hakims. The different treatments prescribed to women ranged from oral and intravaginal medications to various home remedies including refraining from specific foods. Causes of reproductive tract infections reported were "melting bones", consuming foods with perceived hot composition, poor personal hygiene and procedures like dilatation and curettage, delivery and induced abortions. None reported sexually transmitted diseases as the perceived cause of their problem. Interference with religious activities, sexual relationships or socializing was reported as consequences of reproductive tract infections, in addition to lower abdominal pain, menstrual irregularities, backache and kamzori (weakness). Pakistani women seek care for reproductive tract infections and visit a variety of providers, though causes and treatments offered are usually not related to sexually transmitted diseases. We therefore suggest training of healthcare providers for appropriate counseling and that treatment management protocols be advocated.
Rocha, C S; Rato, L; Martins, A D; Alves, M G; Oliveira, P F
The pineal hormone melatonin controls several physiological functions that reach far beyond the regulation of the circadian rhythm. Moreover, it can be produced in extra-pineal organs such as reproductive organs. The role of melatonin in the mammalian seasonal and circadian rhythm is well known. Nevertheless, its overall effect in male reproductive physiology remains largely unknown. Melatonin is a very powerful endogenous antioxidant that can also be exogenously taken safely. Interestingly, its antioxidant properties have been consistently reported to improve the male reproductive dysfunctions associated with pathological conditions and also with the exposure to toxicants. Nevertheless, the exact molecular mechanisms by which melatonin exerts its action in the male reproductive system remain a matter of debate. Herein, we propose to present an up-to-date overview of the melatonin effects in the male reproductive health and debate future directions to disclose possible sites of melatonin action in male reproductive system. We will discuss not only the role of melatonin during darkness and sleep but also the importance of the antioxidant properties of this hormone to male fertility. Since melatonin readily crosses the physiological barriers, such as the blood-testis barrier, and has a very low toxicity, it appears as an excellent candidate in the prevention and/or treatment of the multiple male reproductive dysfunctions associated with various pathologies.
Gontijo, Daniela Tavares; de Sena e Vasconcelos, Anna Carolina; Monteiro, Rosana Juliet Silva; Facundes, Vera Lúcia Dutra; Trajano, Maria de Fátima Cordeiro; de Lima, Luciane Soares
Occupational therapy can contribute to sexual and reproductive health through health education. The purpose of this study was to describe an occupational therapy intervention aimed at sexual and reproductive health promotion in adolescents. Fifty-eight adolescents were involved in the study, before, during and after the interventions. Educative activities such as puzzles, storytelling, mime and board games were used, which occupational therapy faculty and students had constructed. The games were employed as mediators for gaining knowledge in sexual and reproductive health. Outcome was measured using a questionnaire, audio recordings and field diaries. The data were analysed by descriptive statistics and thematic content analysis. The results showed the adolescents' increased knowledge of sexual and reproductive health information immediately after the intervention. The thematic analysis was grouped into three categories: the adolescents' initial expectations regarding the project, reflections on the process experienced during the interventions and use of educational games by occupational therapists. The importance of rapport and dialogue was highlighted in the construction of interventions based on participatory methods. The absence of a longitudinal follow-up is a limitation in this study. Further research is important to systematically assess sexual health promotion strategies in adolescence.
Habtamu, Demelash; Adamu, Addisie
Street children worldwide do not have the information, skills, health services, and support they need to go through sexual development during adolescence. This study is undertaken to systematically investigate the fit between street children's sexual and reproductive health needs and the existing services. A cross-sectional study was conducted among 422 street children and four service providers. About 72.5% of the respondents were sexually active during data collection and 84.3% of males and 85.7% of females tended to have multiple sexual partners. More than two-thirds (67.3%) of the participants had used at least one type of substance. History of substance use (OR = 2.5; 95% CI = 1.42-4.56) and being on the street for the first one to three years (OR = 5.9; 95% CI = 1.41-7.22) increased the likelihood of having sexual activity. More than half (64.9%) of the street children did not attend any kind of sexual or reproductive health education programs. Lack of information on available services (26.5%) was the biggest barrier for utilization of local sexual and reproductive health services. From the individual interview with coordinator, the financial and networking problems were hindering the service delivery for street children. In conclusion, street children who are special high risk group have not been targeted and hence continue to remain vulnerable and lacking in sexual and reproductive health services and sexual health services are poorly advertised and delivered to them.
Bouchard, Louise; Berthelot, Jean-Marie; Casteigts, Arnaud; Chartier, Mariette; Trugeon, Alain; Warnke, Jan
Health information is indispensable for monitoring the progress that has been made in improving and maintaining population health and health system functions. In the context of health reforms aiming to bring health systems closer to populations and with the objective of consistent health services planning at the community level, access to reliable social and health data has become a major issue. The need to develop specific treatment tools and the appropriation of results by the various actors involved (decision makers, planners, researchers and consumers) are central to the presentations and exchanges in this symposium.
Bergin, M; Wells, John S G; Owen, Sara
This paper seeks to advance the debate that considers critical realism as an alternative approach for understanding gender and mental health and its relatedness to mental health research and practice. The knowledge base of how 'sex' and 'gender' affect mental health and illness is expanding. However, the way we conceptualize gender is significant and challenging as quite often our ability to think about 'gender' as independent of 'sex' is not common. The influences and interplay of how sex (biological) and gender (social) affect mental health and illness requires consideration. Critical realism suggests a shared ontology and epistemology for the natural and social sciences. While much of the debate surrounding gender is guided within a constructivist discourse, an exploration of the concept 'gender' is reflected on and some key realist propositions are considered for mental health research and practice. This is achieved through the works of some key realist theorists. Critical realism offers potential for research and practice in relation to gender and mental health because it facilitates changes in our understanding, while simultaneously, not discarding that which is already known. In so doing, it allows the biological (sex) and social (gender) domains of knowledge for mental health and illness to coexist, without either being reduced to or defined by the other. Arguably, greater depth and explanations for gender and mental health issues are presented within a realist metatheory.
Resnik, David B
Randomized controlled trials (RCTs) are becoming increasingly common in environmental health research. Like all studies involving human subjects, environmental health RCTs raise many ethical challenges, ranging from obtaining informed consent to minimizing risks to protecting privacy and confidentiality. One of the most important issues raised by these studies is whether it is ethical to withhold effective environmental health interventions from research subjects in order to satisfy scientific objectives. Although environmental health investigators usually do not have professional obligations to provide medical care to research subjects, they have ethical obligations to avoid exploiting them. Withholding interventions from research subjects can be ethical, provided that it does not lead to exploitation of individuals or groups. To avoid exploiting individuals or groups, investigators should ensure that research subjects and study populations receive a fair share of the benefits of research.
Manore, Melinda M; Kam, Lynn Ciadella; Loucks, Anne B
This paper, which was part of the International Association of Athletics Federations (IAAF) 2007 Nutritional Consensus Conference, briefly reviews the components of the female athlete triad (Triad): energy availability, menstrual status, and bone health. Each component of the Triad spans a continuum from health to disease, and female athletes can have symptoms related to each component of the Triad to different degrees. Low energy availability is the primary factor that impairs menstrual dysfunction and bone health in the Triad. We discuss nutritional issues associated with the Triad, focusing on intakes of macronutrients needed for good health, and stress fractures, the most common injury associated with the Triad. Finally, we briefly discuss screening and treatment for the Triad and the occurrence of the Triad in men.
Campbell, Alastair V
Reproductive medicine has developed to such an extent that numerous moral questions arise about the boundaries of applications of new reproductive technology. It is possible to imagine a future in which 'designer babies' are created and in which cloning, sex selection and male pregnancy become the instruments of individual desire or social policy. In this article, the concept of 'natural' is explored but rejected as an insufficient moral criterion for deciding these complex questions. A case is made for the criterion of welfare of the child and for the concept of the child as gift rather than product.
Hogan, Karen A.; Scott, Cheryl Siegel; Cooper, Glinda S.; Bale, Ambuja S.; Kopylev, Leonid; Barone, Stanley; Makris, Susan L.; Glenn, Barbara; Subramaniam, Ravi P.; Gwinn, Maureen R.; Dzubow, Rebecca C.; Chiu, Weihsueh A.
Background: The U.S. Environmental Protection Agency (EPA) completed a toxicological review of tetrachloroethylene (perchloroethylene, PCE) in February 2012 in support of the Integrated Risk Information System (IRIS). Objectives: We reviewed key findings and scientific issues regarding the human health effects of PCE described in the U.S. EPA’s Toxicological Review of Tetrachloroethylene (Perchloroethylene). Methods: The updated assessment of PCE synthesized and characterized a substantial database of epidemiological, experimental animal, and mechanistic studies. Key scientific issues were addressed through modeling of PCE toxicokinetics, synthesis of evidence from neurological studies, and analyses of toxicokinetic, mechanistic, and other factors (tumor latency, severity, and background rate) in interpreting experimental animal cancer findings. Considerations in evaluating epidemiological studies included the quality (e.g., specificity) of the exposure assessment methods and other essential design features, and the potential for alternative explanations for observed associations (e.g., bias or confounding). Discussion: Toxicokinetic modeling aided in characterizing the complex metabolism and multiple metabolites that contribute to PCE toxicity. The exposure assessment approach—a key evaluation factor for epidemiological studies of bladder cancer, non-Hodgkin lymphoma, and multiple myeloma—provided suggestive evidence of carcinogenicity. Bioassay data provided conclusive evidence of carcinogenicity in experimental animals. Neurotoxicity was identified as a sensitive noncancer health effect, occurring at low exposures: a conclusion supported by multiple studies. Evidence was integrated from human, experimental animal, and mechanistic data sets in assessing adverse health effects of PCE. Conclusions: PCE is likely to be carcinogenic to humans. Neurotoxicity is a sensitive adverse health effect of PCE. Citation: Guyton KZ, Hogan KA, Scott CS, Cooper GS, Bale AS
Swatzyna, Ronald J; Pillai, Vijayan Kumara
The objective of this study is to empirically test the effects of disasters which include natural as well as human made disasters such as armed conflict on women's reproductive health in developing countries. Data from 128 developing countries are used. It was found that average number of deaths from natural disasters and armed conflict in the East Asia and Pacific region was not significantly different from the rest of the developing world. The data are examined using structural equation analysis. This study finds that 'armed conflict' in developing countries presents significant reproductive health risks. The implications are discussed.
Swatzyna, Ronald J.; Pillai, Vijayan K.
The objective of this study is to empirically test the effects of disasters which include natural as well as human made disasters such as armed conflict on women's reproductive health in developing countries. Data from 128 developing countries are used. It was found that average number of deaths from natural disasters and armed conflict in the East Asia and Pacific region was not significantly different from the rest of the developing world. The data are examined using structural equation analysis. This study finds that ‘armed conflict’ in developing countries presents significant reproductive health risks. The implications are discussed. PMID:23777727
Moronkola, O A; Fakeye, J A
Adolescents in sub-Saharan African countries constitute a large proportion of the population. They are sexually active, engage in unsafe reproductive health behavior with attendant consequences but lack appropriate reproductive health education. In the Nigeria Nation Reproductive Health Strategy Framework and Plan, the status of adolescents' reproductive health care is considered low. This study assessed reproductive health knowledge, sexual partners, contraceptive use, and motives for premarital sex among female sub-urban Nigerian secondary students. The study was cross-sectional, involving 500 senior secondary 1 and 2 female sub-urban students. The instrument used was a self-administered questionnaire. Data were analyzed using SPSS. More than 70.0% of the respondents had knowledge of all reproductive health items; male and female condoms were popular contraceptives. At least 53.4% were sexually active and a majority (49.6%) had boyfriends as sex partners. Peer pressure (31.6%) and fun/pleasure (29.2%) were major motives for engaging in premarital sex. Majority (40.3%) terminated pregnancies through self-medication. Though respondents had knowledge of reproductive health, there is need to introduce health education (incorporating reproductive health education) as a core subject in schools as well as provision of youth-friendly health facilities.
Bazarganipour, Fatemeh; Foroozanfard, Fatemeh; Taghavi, Seyed Abdolvahab; Hekmatzadeh, Fatemeh; Sarviye, Malihe
Objective To evaluate reproductive health education which is essential to the prevention of sexual risk behavior and its associated adverse outcomes of unwanted pregnancy, AIDS and other sexually transmitted disease in adolescents. Little is known about youth educational needs about reproductive health in Iran. The aim of this study is evaluation of female youth educational needs about reproductive health in non-medical universities in the city of Qom, north central of Iran. Materials and methods The study was descriptive-analytical type conducted in nine non-medical universities (400 students). A questionnaire was constructed to meet the purpose of the study based on similar studies of knowledge and attitude in different countries, yet it was modified according to Iranian culture and social norms. Results The findings showed that a majority of participants have moderate knowledge about all components of reproductive health. Approximately, one - third of the participants reported difficulties to discuss about sexual health with mothers. The most of the participants believed insufficient female youth reproductive health services and low knowledge about reproductive health were the main barriers for female youth reproductive health aims. Conclusion The participants in this study are representatives of an important subgroup in Iran in order to evaluate female youth reproductive health educational needs. The study identified many misconception and negative attitude that need to be addressed. A health education program through parents, peers, mass media campaign and more comprehensive family planning curriculum in universities are recommended to overcome misconception and spread awareness. PMID:24971106
Cohen, S A
According to the UN High Commissioner for Refugees, there are approximately 40 million refugees and other internally displaced people worldwide, with the overwhelming majority coming from and still living in developed countries. 80% of all refugees are estimated to be women and children. Many refugees spend months and even years in what are designed to be temporary settings where efforts are made to accommodate their basic needs such as food, clean water, shelter, security, and primary health care during emergency situations. Women refugees, however, have certain unique needs beyond what traditionally have been considered basic in relief programs. Many women in developing countries suffer considerable health risks during the best of times due to their poverty or low social status. When fleeing conflict or natural disaster, their health status is at even higher risk of being compromised by severe living conditions and the complete absence of reproductive health services. The recognition that women refugees often face serious and sometimes life-threatening reproductive health-related situations led to the development of a field manual on reproductive health for use at the local level. Planned for publication in late 1998 or early 1999, the guide will describe the goals of a minimum array of reproductive health services in the early phase of an emergency and provide direct guidance on care relating to sexual violence, STDs, family planning, adolescents' needs, and other reproductive health concerns such as female genital mutilation and treatment for septic and incomplete abortion. The manual has garnered worldwide attention and support, as well as scrutiny by abortion opponents in the US, in particular New Jersey Republican Representative Chris Smith.
Olson, Debra; Leitheiser, Aggie; Atchison, Christopher; Larson, Susan; Homzik, Cassandra
On December 15, 2003, the Centers for Public Health Preparedness at the University of Minnesota and the University of Iowa convened the "Public Health and Terrorism Preparedness: Cross-Border Issues Roundtable." The purpose of the roundtable was to gather public health professionals and government agency representatives at the state, provincial, and local levels to identify unmet cross-border emergency preparedness and response needs and develop strategies for addressing these needs. Representatives from six state and local public health departments and three provincial governments were invited to identify cross-border needs and issues using a nominal group process. The result of the roundtable was identification of the needs considered most important and most doable across all the focus groups. The need to collaborate on and exchange plans and protocols among agencies was identified as most important and most doable across all groups. Development of contact protocols and creation and maintenance of a contact database was also considered important and doable for a majority of groups. Other needs ranked important across the majority of groups included specific isolation and quarantine protocols for multi-state responses; a system for rapid and secure exchange of information; specific protocols for sharing human resources across borders, including emergency credentials for physicians and health care workers; and a specific protocol to coordinate Strategic National Stockpile mechanisms across border communities.
Claxton, L D; Barry, P Z
Chemical mutagens are recognized as prevalent in the environment and a potential threat to the health of future generations. This paper presents an overview of chemical mutagenesis as an issue for public health. Several problems in the determination of risk to human populations are discussed, including difficulties of extrapolating scientific data to humans, the latency period between exposure and recognizable genetic damage, and the large number of chemicals which must be tested. Test systems are described. Possibilities of control through federal regulation are discussed. PMID:911015
Vega, W A; Lopez, S R
This paper identifies issues and trends affecting the quality and comprehensiveness of Latino mental health research and services. These issues include current patterns of need and services use, rapid expansion of the Latino population, extraordinary rates of uninsured, social and language barriers to care, transformation in treatment science and technology, and the sheer complexity and rapid changes in the delivery system. Progress in the field requires coordination and investments from both public and private sectors. Scientific journals should provide assistance for creating a high quality knowledge base and rapidly disseminating this information to students, practitioners, and policy makers. Vigorous activity is needed to (1) augment the supply of people entering the "pipeline" for researcher and practitioner training, and (2) support research in priority areas such as outcome studies for diverse treatments and different sectors of care, cultural competence, treatment models for youth and aging populations, quality of care, and barriers to mental health care.
Ozair, Fouzia F.; Jamshed, Nayer; Sharma, Amit; Aggarwal, Praveen
Electronic health record (EHR) is increasingly being implemented in many developing countries. It is the need of the hour because it improves the quality of health care and is also cost-effective. Technologies can introduce some hazards hence safety of information in the system is a real challenge. Recent news of security breaches has put a question mark on this system. Despite its increased usefulness, and increasing enthusiasm in its adoption, not much attention is being paid to the ethical issues that might arise. Securing EHR with an encrypted password is a probable option. The purpose of this article is to discuss the various ethical issues arising in the use of the EHRs and their possible solutions. PMID:25878950
Bugarín-González, R; Bugarín-Diz, C
Gender violence is a health problem that occasionally gives rise to ethical dilemmas for the family doctor. One of the most important conflict is probably when a patient admits to being abused by her partner, but appeals to keep the information confidential, and refuses to present an injury report. There also other problematic situations. This essay attempts to reflect on these issues and help professionals in making decisions.
Stanley, Mary Jo; Rojas, Deb
Schools of nursing are challenged to find clinical placements in public health settings. Use of simulation can address situations unique to public health, with attention to specific concerns, such as environmental health. Environmental health is an integral part of public health nursing and is a standard of professional practice. Current simulations focus on acute care situations, offering limited scenarios with a public health perspective and excluding environmental health. This study's simulation scenario was created to enhance nursing students' understanding of public health concepts within an environmental health context. Outcomes from the simulation include the need for integration of environmental issues in public health teaching. Students stated that this scenario provided a broader understanding of the environmental influences that can affect the client's and family's health. This scenario fills a void in simulation content, while providing an interactive teaching and learning strategy to help students to apply knowledge to practice.
Colombini, Manuela; Rechel, Bernd; Mayhew, Susannah H
The purpose of this study was to explore access of Roma in South-Eastern Europe to sexual and reproductive health services. We conducted 7 focus group discussions with a total of 58 participants from Roma communities in Albania, Bulgaria and Macedonia. Our study revealed a number of barriers for Roma when accessing sexual and reproductive health services. Among the most important were the overall lack of financial resources, requests by health care providers for informal payments, lack of health insurance and geographical barriers. Health systems in the region seem to have failed to provide financial protection and equitable services to one of the most vulnerable groups of society. There is also a need for overcoming racial discrimination, improving awareness and information and addressing gender inequalities.
Parenthood is a fundamental feature of all known life. However, infertility has been recognized as a public health issue worldwide. But even when the offspring are conceived, in utero problems can lead to immediate (abortion), early (birth), and late (adulthood) consequences. One of the most studied factors is stress. However, stress response is, per se, of adaptive nature allowing the organism to cope with challenges. Stressors lead to deterioration if one is faced with too long lasting, too many, and seemingly unsolvable situations. In stress adaptation the hypothalamus-pituitary-adrenocortical axis and the resulting glucocorticoid elevation are one of the most important mechanisms. At cellular level stress can be defined as an unbalance between production of free radicals and antioxidant defenses. Oxidative stress is widely accepted as an important pathogenic mechanism in different diseases including infertility. On the other hand, the goal of free radical production is to protect the cells from infectious entities. This review aims to summarize the negative and positive influence of stress on reproduction as a process leading to healthy progeny. Special emphasis was given to the balance at the level of the organism and cells. PMID:25945091
Eisenberg, Michael L
Approximately 15% of all couples are unable to conceive after a year and are labeled infertile. In recent years, increasing attention has been given to lifestyle factors that may impact fertility. In the United States, it is estimated that there are more than 17 million current users of marijuana with 4.6 million using marijuana almost daily. Although common, to date, little data exist on the impact of marijuana use on male fertility. In the current issue of the Journal, Gundersen et al. (Am J Epidemiol. 2015;182(6):473-481) provide data examining the relationship between marijuana use and semen quality from young men recruited out of the general Danish population. Men who reported daily marijuana use displayed significant lower sperm concentration and sperm counts compared with nonusers, while testosterone levels were higher. The current report provides important information for patients and providers regarding the negative association of marijuana use on semen quality. Although the benefit of marijuana cessation on recovery is uncertain, further study on the impact of marijuana use on male reproductive health is warranted as more states explore marijuana legalization.
Hemberg, E; Kindahl, H; Lundeheim, N; Einarsson, S
The objectives of this study were to investigate: (i) relationships between early foal health and their dams' reproductive health at mating/conception as well as after parturition and (ii) health status during early foal life and its association with performance as an adult. The study included 35 foals showing clinical symptoms indicating septicaemia, sometimes in combination with other disturbances, within their first 18 h postpartum (Group I). Eighty-eight foals that were healthy during their first few days of life were used as control (Group II). All foals were born in the same region of Sweden and during the same period, and were expected to become performance athletes based upon the pedigree of their parents. Cytological and bacteriological examination of uterus at the time of mating/insemination at which the foal was conceived, revealed no difference between dams of Group I and Group II foals. Within 2-3 days after parturition, 29% and 4% of dams (p < 0.001) of Group I and Group II foals had metritis, respectively. At 30 days post-parturition, 64% of the dams of Group I foals and 32% of the dams of Group II foals (p = 0.002) had cytological indication of endometritis, and 57% of the dams of Group I foals and 21% of the dams of Group II foals (p < 0.001) showed bacterial growth upon culture. Altogether 29% of the Group I foals and 7% of the Group II foals were killed or died before 2 years of age (p = 0.001). The majority of the remaining Group I foals were poor performers and some were used just for pleasure riding. It is hypothesized that (i) mares--delivering foals that compromised within their first 18 h postpartum--might have suffered from an ascending infection during late gestation and (ii) health status during early foal life might be associated with their performance as adult.
Windisch, Ricarda; de Savigny, Don; Onadja, Geneviève; Somda, Antoine; Wyss, Kaspar; Sié, Ali; Kouyaté, Bocar
Organizational changes, increased funding and the demands of HIV antiretroviral (ARV) treatment create particular challenges for governance in the health sector. We assess resource allocation, policy making and integration of the national responses to ARV provision and reproductive health in Burkina Faso, using national and district budgets related to disease burden, policy documents, organizational structures, and coordination and implementation processes. ARV provision represents the concept of a "crisis scenario", in which reforms are pushed due to a perception of urgent need, whereas the national reproductive health programme, which is older and more integrated, represents a "politics-as-usual scenario". Findings show that the early years of the national response to HIV and AIDS were characterized by new institutions with overlapping functions, and failure to integrate with and strengthen existing structures. National and district budget allocations for HIV compared to other interventions were disproportionately high when assessed against burden of disease. Strategic documents for ARV provision were relatively less developed and referred to, compared to those of the Ministry of Health Directorates for HIV and for Family Health and district health planning teams for reproductive health services. Imbalances and new structures potentially trigger important adverse effects which are difficult to remedy and likely to increase due to the dynamics they create. It therefore becomes crucial, from the outset, to integrate HIV/AIDS funding and responses into health systems.
Hakamies, Nina; Geissler, Paul Wenzel; Borchert, Matthias
Reproductive health care for internally displaced persons (IDPs) is recognised by the Inter-Agency Working Group on Reproductive Health in Refugee Situations and the Reproductive Health Response in Conflict Consortium as a neglected area in humanitarian relief operations. To identify barriers to agencies providing reproductive health care to IDPs, and their strategies for overcoming these barriers, we interviewed representatives of 12 relief and development agencies providing health care to conflict-affected populations. Although material and human resources are significant constraints on agencies, the main challenge is to tackle ideological, managerial and policy barriers, and those related to donor influence. The absence of a legal instrument that recognises IDPs internationally has contributed to the difficulties agencies face in systematically reaching IDPs. Our findings suggest that considerable efforts are needed to close the gap between international commitments and the provision of services at field level. We recommend that agencies carry out awareness-raising activities internally and among partner organisations and donors, strengthen internal organisation and inter-agency collaboration and share expertise in order to maximise benefits and save resources at the local level. We also recommend exploring the possibility of an international convention to protect the rights of internally displaced persons.
Fiala, Christian; Gemzell Danielsson, Kristina; Heikinheimo, Oskari; Guðmundsson, Jens A; Arthur, Joyce
Reproductive health care is the only field in medicine where health care professionals (HCPs) are allowed to limit a patient's access to a legal medical treatment - usually abortion or contraception - by citing their 'freedom of conscience.' However, the authors' position is that 'conscientious objection' ('CO') in reproductive health care should be called dishonourable disobedience because it violates medical ethics and the right to lawful health care, and should therefore be disallowed. Three countries - Sweden, Finland, and Iceland - do not generally permit HCPs in the public health care system to refuse to perform a legal medical service for reasons of 'CO' when the service is part of their professional duties. The purpose of investigating the laws and experiences of these countries was to show that disallowing 'CO' is workable and beneficial. It facilitates good access to reproductive health services because it reduces barriers and delays. Other benefits include the prioritisation of evidence-based medicine, rational arguments, and democratic laws over faith-based refusals. Most notably, disallowing 'CO' protects women's basic human rights, avoiding both discrimination and harms to health. Finally, holding HCPs accountable for their professional obligations to patients does not result in negative impacts. Almost all HCPs and medical students in Sweden, Finland, and Iceland who object to abortion or contraception are able to find work in another field of medicine. The key to successfully disallowing 'CO' is a country's strong prior acceptance of women's civil rights, including their right to health care.
Background The current conflict in Syria continues to displace thousands to neighboring countries, including Lebanon. Information is needed to provide adequate health and related services particularly to women in this displaced population. Methods We conducted a needs assessment in Lebanon (June-August 2012), administering a cross-sectional survey in six health clinics. Information was collected on reproductive and general health status, conflict violence, stress, and help-seeking behaviors of displaced Syrian women. Bivariate and multivariate analyses were conducted to examine associations between exposure to conflict violence, stress, and reproductive health outcomes. Results We interviewed 452 Syrian refugee women ages 18–45 who had been in Lebanon for an average of 5.1 (± 3.7) months. Reported gynecologic conditions were common, including: menstrual irregularity, 53.5%; severe pelvic pain, 51.6%; and reproductive tract infections, 53.3%. Among the pregnancy subset (n = 74), 39.5% of currently pregnant women experienced complications and 36.8% of those who completed pregnancies experienced delivery/abortion complications. Adverse birth outcomes included: low birthweight, 10.5%; preterm delivery, 26.5%; and infant mortality, 2.9%. Of women who experienced conflict-related violence (30.8%) and non-partner sexual violence (3.1%), the majority did not seek medical care (64.6%). Conflict violence and stress score was significantly associated with reported gynecologic conditions, and stress score was found to mediate the relationship between exposure to conflict violence and self-rated health. Conclusions This study contributes to the understanding of experience of conflict violence among women, stress, and reproductive health needs. Findings demonstrate the need for better targeting of reproductive health services in refugee settings, as well as referral to psychosocial services for survivors of violence. PMID:24552142
Casey, M M; Wellever, A; Moscovice, I
Rural health networks are a potential way for rural health care systems to improve access to care, reduce costs, and enhance quality of care. Networks provide a means for rural providers to contract with managed care organizations, develop their own managed care entities, share resources, and structure practice opportunities to support recruitment and retention of rural physicians and other health care professionals. The results of early network development initiatives indicate a need for state officials and others interested in encouraging network development to agree on common rural health network definitions, to identify clearly the goals of network development programs, and to document and analyze program outcomes. Future network development efforts need to be much more comprehensive if they are to have a significant impact on rural health care. This article analyzes public policy issues related to integrated rural health network development, discusses current efforts to encourage network development in rural areas, and suggests actions that states may take if they desire to support rural health network development. These actions include adopting a formal rural health network definition, providing networks with alternatives to certain regulatory requirements, and providing incentives such as matching grants, loans, or technical assistance. Without public sector support for networks, managed care options may continue to be unavailable in many less densely populated rural areas of the country, and locally controlled rural health networks are unlikely to develop as an alternative to the dominant pattern of managed care expansion by large urban entities. Implementation of Medicare reform legislation could provide significant incentives for the development of rural health networks, depending on the reimbursement provisions, financial solvency standards, and antitrust exemptions for provider-sponsored networks in the final legislation and federal regulations.
Ngwena, Charles G; Brookman-Amissah, Eunice; Skuster, Patty
The African Commission on Human and Peoples' Rights recently adopted General Comment No 2 to interpret provisions of Article 14 of the Protocol to the African Charter on the Rights Women. The provisions relate to women's rights to fertility control, contraception, family planning, information and education, and abortion. The present article highlights the General Comment's potential to promote women's sexual and reproductive rights in multiple ways. The General Comment's human rights value goes beyond providing states with guidance for framing their domestic laws, practices, and policies to comply with treaty obligations. General Comment No 2 is invaluable in educating all stakeholders-including healthcare providers, lawyers, policymakers, and judicial officers at the domestic level-about pertinent jurisprudence. Civil society and human rights advocates can use the General Comment to render the state accountable for failure to implement its treaty obligations.
Averitt Taylor, Jessica
This article provides an overview of the historical arguments surrounding reproductive health policy and current policy initiatives. Because reproductive policy itself is a vast subject matter with sometimes blurry boundaries, the struggle concerning the advent of birth control is used to illustrate the historic complexities of policy affecting such a wide array of individuals. The battle over introduction of the birth control pill is pertinent because the very same arguments are used today in debates over reproductive health policy.
Gordon, Paul R
Complicated health care policy decisions are generally made by elected officials. The officials making these complicated decisions are elected by the people, and citizens' participation in the voting process is one of the basic tenets of democracy. Voters in the United States, who are also patients in the health care system, receive enormous amounts of information throughout election cycles. This information is generally delivered in sound bites often intended to elicit an emotional reaction rather than simply inform. From April through July 2016, the author-an academic physician-rode a bicycle across the United States and met with people in small rural towns to ask them their understanding of the Affordable Care Act and the impact it has had on their lives. In this Commentary the author shares some of those stories, which are often informed by sound bites and misinformation. The author argues that it is the role of academic physicians to educate not only students and residents but also patients. In addition to providing information about patients' medical problems, physicians can educate them about the health care policy issues that are decided by elected officials.A doctor can help educate patients about these issues to facilitate their making informed decisions in elections. Physicians have a role and responsibility in society as a knowledgeable person to make the health care system be the best it can be for the most people.
MacPherson, Eleanor E.; Richards, Esther; Namakhoma, Ireen; Theobald, Sally
Background Gender inequalities are important social determinants of health. We set out to critically review the literature relating to gender equity and sexual and reproductive health (SRH) in Eastern and Southern Africa with the aim of identifying priorities for action. Design During November 2011, we identified studies relating to SRH and gender equity through a comprehensive literature search. Results We found gender inequalities to be common across a range of health issues relating to SRH with women being particularly disadvantaged. Social and biological determinants combined to increase women's vulnerability to maternal mortality, HIV, and gender-based violence. Health systems significantly disadvantaged women in terms of access to care. Men fared worse in relation to HIV testing and care with social norms leading to men presenting later for treatment. Conclusions Gender inequity in SRH requires multiple complementary approaches to address the structural drivers of unequal health outcomes. These could include interventions that alter the structural environment in which ill-health is created. Interventions are required both within and beyond the health system. PMID:24972916
Martin, R A
All published research examining effects of humor and laughter on physical health is reviewed. Potential causal mechanisms and methodological issues are discussed. Laboratory experiments have shown some effects of exposure to comedy on several components of immunity, although the findings are inconsistent and most of the studies have methodological problems. There is also some evidence of analgesic effects of exposure to comedy, although similar findings are obtained with negative emotions. Few significant correlations have been found between trait measures of humor and immunity, pain tolerance, or self-reported illness symptoms. There is also little evidence of stress-moderating effects of humor on physical health variables and no evidence of increased longevity with greater humor. More rigorous and theoretically informed research is needed before firm conclusions can be drawn about possible health benefits of humor and laughter.
Greenley, J R
Fragmented and often uncoordinated public services for the more severely mentally ill are often characteristic of the current U.S. mental health system. The creation of local mental health authorities has been promoted as part of a solution, as has happened in Wisconsin at the county level and is championed in the ongoing Robert Wood Johnson Foundation funded innovative service sites for severely mentally ill adults. There are indications that these innovative mental health authorities will fall short of fulfilling their promise. Basic principles from the management and organizations literature are used to identify several organization and management issues that may have been neglected. These include resource management, attention to system goals, monitoring and feedback, and the promotion of desirable interorganizational cultures.
Similar to other countries, there have been a number of high-profile reports into past and recent cases of child abuse and neglect in Ireland. The most recent of these have been the Monageer Inquiry, the Ryan Report, the Roscommon Child Care Case and the Report of the Independent Child Death Review Group. An analysis of these reports highlights the critical role played by public health nurses with troubled families. It also makes explicit key issues that consistently emerge as problematic in terms of professional practice. This paper summarises the main findings of the reports as they relate to the public health nursing service and identifies key themes emerging along with recommendations arising. The emerging themes relate to assessment, early intervention, record keeping, communication and interdisciplinary working and the role of public health nursing management.
The application of behavioral economics to health and health care has captured the imagination of policymakers across the political spectrum. The idea is that many people are irrational in predictable ways, and that this both contributes to unhealthy behaviors like smoking and holds one of the keys to changing those behaviors. Because health care costs continue to increase, and a substantial portion of costs are incurred because of unhealthy behaviors, employers and insurers have great interest in using financial incentives to change behaviors. However, it is in the details that complexity and controversies emerge. Who should the targets be, and what outcomes should be rewarded? How should incentives be structured, to maximize their effectiveness and minimize unintended consequences? In what situations should we be intervening to affect decisions by people who may prefer to be obese or to smoke, and in what situations should we accept their preferences? To begin to answer these questions, the Penn-CMU Roybal P30 Center on Behavioral Economics and Health held its first annual Behavioral Economics and Health Symposium on March 24-25, 2011 with support from the Robert Wood Johnson Foundation. The symposium drew more than 50 researchers, scholars, and health professionals from a variety of disciplines, including medicine, public health, economics, law, management, marketing, and psychology. They heard perspectives on behavioral economics from public and private funders, the CEO of the University of Pennsylvania Health System, and the CEO of stickK.com, a start-up company that uses online, voluntary commitment contracts to help people achieve their goals. Participants formed eight working groups to review the current state-of-the-art in a variety of clinical contexts and to consider how behavioral economics could inform a research agenda to improve health. This Issue Brief summarizes the findings of these working groups and the symposium.
Ducat, Lee; Rubenstein, Arthur; Philipson, Louis H; Anderson, Barbara J
Individuals with type 1 diabetes are at increased risk for depression, anxiety disorder, and eating disorder diagnoses. People with type 1 diabetes are also at risk for subclinical levels of diabetes distress and anxiety. These mental/behavioral health comorbidities of diabetes are associated with poor adherence to treatment and poor glycemic control, thus increasing the risk for serious short- and long-term physical complications, which can result in blindness, amputations, stroke, cognitive decline, decreased quality of life, as well as premature death. When mental health comorbidities of diabetes are not diagnosed and treated, the financial cost to society and health care systems is catastrophic, and the human suffering that results is profound. This review summarizes state-of-the-art presentations and working group scholarly reports from the Mental Health Issues of Diabetes Conference (7-8 October 2013, Philadelphia, PA), which included stakeholders from the National Institutes of Health, people living with type 1 diabetes and their families, diabetes consumer advocacy groups, the insurance industry, as well as psychologists, psychiatrists, endocrinologists, and nurse practitioners who are all nationally and internationally recognized experts in type 1 diabetes research and care. At this landmark conference current evidence for the incidence and the consequences of mental health problems in type 1 diabetes was presented, supporting the integration of mental health screening and mental health care into routine diabetes medical care. Future research directions were recommended to establish the efficacy and cost-effectiveness of paradigms of diabetes care in which physical and mental health care are both priorities.
Oni, Gbolahan; Fatusi, Adesegun; Tsui, Amy; Enquselassie, Fikre; Ojengbede, Oladosu; Agbenyega, Tsiri; Ojofeitimi, Ebenezer; Taulo, Frank; Quakyi, Isabella
Poor reproductive health constitutes one of the leading public health problems in the world, particularly in sub-Saharan Africa (SSA). We report here an academic partnership that commenced in 2003 between a US institution and six universities in SSA. The partnership addresses the human resources development challenge in Africa by strengthening public health education and research capacity to improve population and reproductive health (PRH) outcomes in low-resource settings. The partnership's core activities focused on increasing access to quality education, strengthening health research capacity and translating scholarship and science into policy and practices. Partnership programmes focused on the educational dimension of the human resources equation provide students with improved learning facilities and enhanced work environments and also provide faculty with opportunities for professional development and an enhanced capacity for curriculum delivery. By 2007, 48 faculty members from the six universities in SSA attended PRH courses at Johns Hopkins University, 93 PRH courses were offered across the six universities, 625 of their master's students elected PRH concentrations and 158 had graduated. With the graduation of these and future student cohorts, the universities in SSA will systematically be expanding the number of public health practitioners and strengthening programme effectiveness to resolve reproductive health needs. Some challenges facing the partnership are described in this article.
Manlove, Jennifer; Terry-Humen, Elizabeth; Ikramullah, Erum; Holcombe, Emily
When it comes to the reproductive health behaviors of teens and young adults, far more public attention has focused on women than on men. That's not surprising. After all, men don't actually have the babies. Yet the importance of understanding men's reproductive health behaviors should not be overlooked, given their potential implications for men…
Tangmunkongvorakul, Arunrat; Banwell, Cathy; Carmichael, Gordon; Utomo, Iwu Dwisetyani; Seubsman, Sam-Ang; Kelly, Matthew; Sleigh, Adrian
This study sheds light on obstacles to safe sexual health for young Thais and their need for appropriate sexual and reproductive health services. The study population was 1,745 unmarried adolescents aged 17-20 who resided or worked in Chiang Mai, the major city in northern Thailand. The study used quantitative and qualitative methods to explore the vulnerability of sexually active adolescents as well as the lack of support and care for them from parents and health providers. We found that young Thais still prefer pharmacies for self-medication and use government health care facilities as a last resort. Current health services are not suitable for young people in northern Thailand because they lack privacy and impose judgemental attitudes, especially towards sexually active adolescent females. Current programs for adolescent sexual and reproductive health focus on education and counselling and do not provide appropriate privacy or clinical care. There is a pressing need for advocacy, policy support for the development of youth-friendly sexual and reproductive health services in Thailand. PMID:23082599
Lauen, Joanna; Henderson, Dorothy; White, Barbara; Kohchi, Joaniko
Achieving reproductive health and justice matters to family and child well-being. These two ideals are, however, often put at odds in public policies and discourse that shape the systems and programs that affect pregnant women and families. This article describes the Irving Harris Foundation's historic approach to investing in early childhood and…
The purpose of this study is to determine the understanding of reproductive health among parents and female adolescents with Down syndrome. This cross-sectional study involved 22 parents and 22 female adolescents with Down syndrome in Kuala Lumpur, Malaysia. The parents were required to fill up the socio-demographic information in questionnaire…
Orza, Luisa; Crone, Tyler; Mellin, Julie; Westerhof, Nienke; Stackpool-Moore, Lucy; Restoy, Enrique; Gray, Greg; Stevenson, Jacqui
Sexual and reproductive health and rights have gained prominence in the HIV response. The role of sexual and reproductive health in underpinning a successful approach to HIV prevention, treatment, care, and services has increasingly been recognized. However, the "second R," referring to sexual and reproductive rights, is often neglected. This leads to policies and programs which both fail to uphold and fulfill these rights and which fail to meet the needs of those most affected by HIV by neglecting to take account of the human right-based barriers and challenges they face. In this commentary, the authors draw on the approach and practical experiences of the Link Up program, and the findings of a global consultation led for and by young people living with and most affected by HIV, to present a five-point framework to improve programming and health outomces by better protecting, respecting, and fulfilling the sexual health and reproductive rights of young people living with and most vulnerable to HIV.
The discovery in the mid-1970s that occupational exposures to pesticides could diminish or destroy the fertility of workers sparked concern about the effects of hazardous substances on male reproductive health. More recently, there is evidence that sperm quantity and quality may ...
van der Geugten, Jolien; Dijkstra, Marlies; van Meijel, Berno; den Uyl, Marion H. G.; de Vries, Nanne K.
There have been few assessments of sexual and reproductive health (SRH) education programmes in sub-Saharan Africa from the students' and educators' perspective. This study examined students' opinions on an SRH programme in northern Ghana and explored the facilitators and barriers for educators regarding the implementation of the programme. The…
Reeve, Charlie L.; Basalik, Debra
The current study examines the degree to which state intellectual capital, state religiosity and reproductive health form a meaningful nexus of ecological relations. Though the specific magnitude of effects vary across outcomes, results from hierarchical regression analyses were consistent with the hypothesized path model indicating that a state's…
Summerville, Geri; Canova, Karen
Launched by the Annie E. Casey Foundation in the early 1990s, Plain Talk is a community-based initiative that seeks to reduce the incidence of teen pregnancy and STDs by improving adult/teen communication about sex. A key component of the program is parental involvement--which was once seen by many in the adolescent reproductive health (ARH) field…
This article concerns a 3-year materials development project that was implemented by the Indonesian Planned Parenthood Association and the Bureau of Non-Physical Family Resilience. The project was developed in response to the need for improving adolescent reproductive health in Jakarta, Yogyakarta and West Java, where adolescent problems have been increasing during the last decade. The project's long-term goal is centered on raising the commitment of families to instill in their children a better understanding of adolescent reproductive health concepts and desirable family values. For its short-term objectives, the project seeks to develop a basic information, education and communication (IEC)/counseling strategy and policy in support of a family-centered approach to adolescent reproductive health; promote better understanding of reproductive health needs of adolescents among the policy-makers; and improving the IEC/counseling skills of personnel at the community level. The project used five strategies to achieve its goals; namely, 1) preparation of a media development and production plan; 2) conducting a needs assessment; 3) production of three types of materials; 4) implementation of three key activities; and 5) periodic monitoring of activities.