产后性问题与产后保健服务

目的 :了解产后各种不同类型性问题的发生率以及在产后保健服务中对性健康重视的状况。方法 :采用横断面研究方法 ,将分娩活婴的 4 6 0例初产妇产科住院记录和产后 6月门诊随访问卷调查所得资料进行分析。结果 :94 74 %初产妇于产后 6月内恢复性生活 ,但妇女性问题的发生率较产前明显增加。其中 ,产后 3月内 70 5 9%存在性问题 ,产后 3～ 6月内下降为 6 4 0 8% ,产后 6月时 ,降至 34 17% ,但未恢复到妊娠前 (7 17% )的水平。产后常见的女性性问题有 :性交疼痛、阴道干涩、性高潮障碍、阴道松弛等 ;其中 ,性交疼痛发生率占第 1位 ,产后 3月内为 6 1 76 % ,产后 6月为 13 2 1%。产后 4 2天接受产科随访时 ,仅 2 0 82 %的妇女从卫生保健人员得到有关的性健康知识。在有产后性问题的妇女中 ,与卫生保健人员讨论过该问题者仅为 8 0 2 %。结论 :产后性健康问题非常普遍 ,但产后保健服务中性健康未得到应有重视 ,缺乏专业人员提供咨询与治疗。提示对产后性问题的咨询与治疗的潜在需求极大 ,值得重视。     

Minority Populations and Health

By TA LaVeist. San Francisco: Jossey‐Bass, 2005. 332 pages. $65.00, hardback. Surviving in the Hour of Darkness: The Health and Wellness of Women of Colour and Indigenous Women By GS Harding, ed. Calgary, Alberta, CA: University of Calgary Press, 2005. 314 pages. $23.00, paperback.     

Social Support and Health

Social involvement plays important roles both in how individuals handle stress and in regimens that support healthy lifestyles. Close relationships and involvement in community activities are predictive of how long a person will live and, for women, of the course of their pregnancies. There are important differences between those aspects of social relationships which are most protective for men and women. Global social involvement seems to be more important for the health of women than for men. While men seem to derive greater benefits from marriage, women seem to be able to profit more from many kinds of relationships, including those with friends, relatives and children. Women also seem to be more prone to experiencing negative effects from social involvement. Physicians should be aware of these differences and be prepared both to provide information and emotional support to women in acute medical crises, and to involve existing social supports in treatment and, if necessary, make referrals to appropriate support groups.     

Pesticides and Health Risks

Pesticides are a category of chemicals formulated to kill or repel a pest or halt its reproduction. In this article we review the toxicological and epidemiological literature; describe common potential pesticide exposures; and focus on the associated health risks to fetal development. Clinical implications are reviewed, and recommendations are made regarding the integration of this environmental health concern into nursing education, practice, research, and policy/advocacy work. Recommendations for pesticide elimination and reduction in health care settings are included.     

Culture and Preventive Health Care

Interviews were conducted with 85 Puerto-Rican-born women encountered in one urban community in the United States concerning their obstetrical and gynecological preventive health participation, modesty pattern, and feelings of being male dominated. Women who were living with partners were influenced in preventive health participation by their modesty pattern: The more modest woman participated less. Women no longer living with their partners participated in preventive health care independently of their modesty pattern. Women reporting to be more male dominated demonstrated no differences in their preventive health participation; however, women reporting to be less male dominated participated more in preventive health. The nurse should determine the degree of modesty and assess its probable influence on the woman s future participation in preventive health. The more modest woman will relate better to a female health provider in matters concerning her physical person, and particularly, in matters concerned with her sexuality. In some instances the nurse should determine the need to include the partner an preventive health education in order to encourage a more positive attitude toward and participation in preventive health care.     

Progestin-Only Contraception and Bone Health

Purpose of Review

Progestin-only contraceptive methods are important and effective options for women trying to prevent unintended pregnancy. There is concern about progestin-only methods and bone health, particularly for depot medroxyprogesterone acetate (DMPA), because progestin-only methods can lower estradiol levels through ovarian suppression. This is of particular concern for adolescents building bone and perimenopausal women heading towards menopause.

Recent Findings

DMPA does cause temporary bone loss, but this is reversible after discontinuation. Evidence is limited as to whether the decreased bone density and subsequent reversal that is seen with DMPA use leads to an increased risk of fracture in the future. Two observational studies indicate a weak association between DMPA use and fracture risk. Progestin-only implants, pills, and the intrauterine device do not have an impact on bone mineral density or fracture risk.

Summary

Use of DMPA or any other progestin-only method should not be restricted due to a theoretical risk of fractures when reproductive-age women face the very real risk of pregnancy.

     

Health hazards and electromagnetic fields

Biological rhythms, physical wellbeing and mental states are dependent on our electrical brainwave system interacting with the extremely weak electromagnetic fields generated by the Earth's telluric and Cosmic radiations. In a single generation, since the evolution of humankind over millions of years, we are exposed to a wide range of powerful, artificially generated electromagnetic radiation which adversely affects the subtle balance in nature's energy fields and has become the source of so-called 'diseases of civilization'. This also includes electromagnetic sensitivity. Generally, there is a lack of awareness and understanding of the impact electromagnetic fields can have upon health and wellbeing.Our ancestors were acutely aware that certain locations, were perceived to have a positive energy field which was beneficial to health and vitality. Over time, these areas are now referred to as sacred sites for spiritual ceremony and as healing centres. In contrast, there are other geographical locations that can have a negative effect upon health and these are known as geopathic stress zones. It is believed that such zones can interfere with the brain's normal function that inhibits the release of melatonin and other endocrine secretions needed to replenish the immune system. Geopathic stress can affect animals and plant life as well as human beings and significantly contributes to sick building syndrome (SBS).Whilst there is an increasing body of opinion amongst eminent researchers and scientists who are addressing these issues, the establishment professions are slow to change. However, very gradually, modern allopathic medicine and attitudes are beginning to recognise the extraordinary wisdom and efficacy of ancient traditions such as acupuncture, light, colour and other therapies based on the understanding and treatment of the interaction of a person's electromagnetic subtle body and the immediate environment. These and many other 'complementary' therapies may soon become mainstream medical practice. In the meantime, we can help ourselves by learning how to detect the hazards and daily practise prudent avoidance.     

Reproductive Coercion and Women's Health

Given the epidemic proportion of those affected, the impact of gender‐based violence looms large in the study of women's health. One increasingly recognized facet of such violence is reproductive coercion, defined as behavior that interferes with autonomous decision‐making in areas of reproductive health. Although the body of literature illustrating the pathology of reproductive coercion is limited, growing data on harms to reproductive choice, health outcomes, and future pregnancies are a sobering appeal for greater publicity and information. This review explores existing knowledge regarding reproductive coercion, highlights areas of future study, and underscores how women's health care providers can better serve this population.     

Hurricane Katrina and Perinatal Health

We review the literature on the effects of Hurricane Katrina on perinatal health, and providing data from our own research on pregnant and postpartum women. After Katrina, obstetric, prenatal, and neonatal care was compromised in the short term, but increases in adverse birth outcomes such as preterm birth, low birthweight, and maternal complications were mostly limited to highly exposed women. Both pregnant and postpartum women had rates of post‐traumatic stress disorder similar to, or lower than, others exposed to Katrina, and rates of depression similar to other pregnant and postpartum populations. Health behaviors, such as smoking and breastfeeding, may have been somewhat negatively affected by the disaster, whereas effects on nutrition were likely associated with limited time, money, and food choices, and indicated by both weight gain and loss. We conclude that, with a few specific exceptions, postdisaster concerns and health outcomes for pregnant and postpartum women were similar to those of other people exposed to Hurricane Katrina. In such situations, disaster planners and researchers should focus on providing care and support for the normal concerns of the peripartum period, such as breastfeeding, depression, and smoking cessation. Contraception needs to be available for those who do not want to become pregnant. Although additional physical and mental health care needs to be provided for the most severely exposed women and their babies, many women are capable of surviving and thriving in postdisaster environments.