Exploring the reproductive decision support needs and preferences of women with cystic fibrosis,

ObjectivesAs women with cystic fibrosis (CF) live longer, healthier lives, they increasingly face decisions related to their reproductive health. This qualitative study explores their unique decision support needs and preferences to aid in the development of a CF-specific reproductive goals decision aid.Study designWomen with CF age 18–44 years participated in individual, semi-structured, telephone-based interviews, and women with CF age 18 years and older participated in semi-structured focus group discussions (FGDs). Both explored experiences and attitudes surrounding parenthood, pregnancy, contraception, and preferences for reproductive health care provision. FGDs also explored the use, content, and format of a reproductive goals decision aid for women with CF. We transcribed interviews and FGDs and conducted content and thematic analyses using an inductive approach.ResultsTwenty women (age range 20–42 years) participated in interviews and 18 women (age range 26–63 years) participated in three FGDs. Major themes identified included: 1) CF complicates pregnancy and parenting decisions; 2) Women make contraceptive decisions within the context of their CF; 3) Women with CF prefer to receive reproductive health counseling from their CF team; 4) Women with CF desire defragmented, coordinated reproductive health care; and 5) A disease-specific reproductive goals decision aid would encourage relevant parenting, pregnancy, and contraceptive discussions.ConclusionWomen with CF have unique reproductive health care needs and often face uncertainty and disjointed care when making reproductive health and contraceptive decisions.ImplicationsThis study underscores the central role of the CF team and illustrates opportunities to better support women with CF in their decisions surrounding sexual and reproductive health, including through a patient-centered, disease-specific, reproductive goals decision aid.     

Physicians’ opinions about the causes of underreporting of occupational diseases

Abstract

Occupational diseases cause an important burden on health and economy; however, they are substantially underestimated. We aimed to investigate the opinions of physicians about causes of underreporting of occupational diseases. We collected data with a questionnaire, listing 30 possible causes for underreporting of occupational diseases. 478 physicians participated in the study. The first 3 most frequent causes perceived as “very important” are; employers’ perception of occupational safety and health services as a loss of revenue (64.9%), prevalent employment without a legal contract (64.6%), and prevalent employment as subcontracted (59.4%). 52.1% of the physicians worked or currently working as an occupational physician. With the increase of working year as an occupational physician, there was a statistically significant decrease in the strength of importance for 17 of the 30 statements. This finding may be one of the important causes of underreporting of occupational diseases.     

Role for Occupational Therapy in Community Mental Health: Using Policy to Advance Scholarship of Practice

ABSTRACT

Occupational therapists must be aware of professional and policy trends. More importantly, occupational therapists must be involved in efforts to influence policy both for the profession and for the people they serve (Bonder, 1987). Using the state of Illinois as an example, this article reviews the policies and initiatives that impact service decisions for persons with psychiatric disabilities as well as the rationale for including occupational therapy in community mental health service provision. Despite challenges in building a workforce of occupational therapists in the mental health system, this article makes the argument that the current climate of emerging policy and litigation combined with the supporting evidence provides the impetus to strengthen mental health as a primary area of practice. Implications for scholarship of practice related to occupational therapy services in community mental health programs for individuals with psychiatric disability are discussed.     

Emerging electronic cigarette policies in European member states,Canada, and the United States

BackgroundIncreased electronic cigarette (ECIG) use has motivated new regulations to address the changing landscape of tobacco use and promote public health.MethodThis policy scan compares ECIG prevalence and regulations in the European Union (EU), Canada, and the United States (US) at the federal- and local-level to foster a policy dialogue around modern tobacco prevention and control regulations.ResultsAmong young adults, 40 % in the US, 29 % in Canada, and 28 % in the EU report ever using an ECIG. Results from the policy scan find significant variation in approach to regulating ECIGs. EU member states are subject to the most stringent requirements regarding nicotine concentration regulations, and several member states have also opted to ban flavors and/or require plain packaging or out of sight retail sales. Among EU and US states, taxation is a popular strategy, though taxing strategies vary widely. Regarding youth use, US states have led the way for increasing the legal age of sale to 21 at the federal level, and in Canada recent federal regulations are innovative in their approach to banning advertising that may appeal to youth.ConclusionStrategies to achieve public health goals related to ECIGs vary widely, with federalism playing an important role in policy innovation, offering opportunities to evaluate their effectiveness and inform future regulations.     

"He told me it would be extremely selfish of me to even consider [having kids]": The importance of reproductive health to women with spina bifida and the lack of support from their providers

BackgroundAs more women with spina bifida (SB) enter their reproductive years, the number having children is significantly increasing. However, little is known about their understanding of their ability to get pregnant or their experiences in considering, planning, or interacting with providers during a pregnancy.ObjectiveWe sought to determine what women have been told and understand about their reproductive health, their attitudes towards having children, and their experiences interacting with providers when seeking reproductive health care.MethodsIn this exploratory study employing qualitative research methods and following Grounded Theory, interviews with women with SB 16 years or older were transcribed verbatim and analyzed by three coders.ResultsInterviews of 25 women with SB ages 16–52 (median 26) revealed the following themes about their reproductive health perceptions and experiences: 1) poor understanding of reproductive health and potential, 2) interest in having a family, 3) facing provider's opposition to their reproductive goals, 4) going into pregnancy and delivery unprepared, 5) the importance of provider support for reproductive goals. Five women experienced an unintended pregnancy.ConclusionsAlthough having children is important to most women with SB in this study, they report a poor understanding of their reproductive potential with several noting unintended pregnancies. They feel uninformed and unprepared during pregnancy and face discouragement from providers. Those experiencing supportive providers report a more positive experience. This demonstrates the urgent need to educate women with SB about their reproductive health and the providers who care for them how to support and counsel these women.     

People centered Science and Globalization: Putting the Public Back into Public Health Policy

Abstract

Developing countries have no. significant policies for occupational health. This analysis identifies four broad mechanisms through which state- and enterprise-level decision makers in developing countries diffuse attemps to instigate improvements in occupational health: inaction or stifling of such efforts during policy implementation; exercise of power; appeal to the existing bias (norms, rules, procedures) of the system; and prevailing dominant ideology. Addressing these limiting factors requires initiating a process of raising the occupational health policy profile that recognizes the importance of empowering workers' organizations, and enabling professionals to play an active role in the generation of occupational health knowledge required to improve occupational health in the developing countries.     

金华市区域卫生规划实践的案例研究

研究发现：（1）即使规划的目标是合理的，在社会经济形势发生变化时，突破规划目标的最大动力恰恰是政府部门自己。（2）从人均卫生总费用增长速度、政府卫生财政补助经费流向和大型医疗设备控制目标实现程度等指标来看，区域卫生规划的目标没有实现。（3）当区域卫生规划没有将控制医疗费用不合理上涨作为规划目标，政府配置卫生资源的力量大幅削弱，没有配套措施调节病人流向时，合理配置卫生资源的目标难以实现。     

Everyday occupations prioritised by older adults participating in reablement. A cross-sectional study

Abstract

Background: Little knowledge exists regarding which occupations older adults prioritize as rehabilitation goals in reablement and what factors are associated with their preferences.

Objectives: To explore which occupations older people with functional decline find important to improve, which of these they prioritize as their rehabilitation goals, and what factors are associated with these priorities.

Materials and methods: A cross-sectional study was undertaken with a sample of 738 older adults from a nationwide trial evaluating the effects of reablement in Norway. The nine occupational sub-areas of the Canadian Occupational Performance Measure were used as a framework for analyses.

Results: Participants identified a multitude of occupations as challenging. Functional mobility was the most frequently identified and prioritized sub-area. Significant associations were found between prioritized occupations and health condition, sex, living status, education, walking speed and motivation.

Conclusions: This study found both abundance and diversity in the occupational problems and prioritized goals of older adults, with mobility being a key priority regardless of health condition.

Significance: It is important that reablement continues to be a person-centered intervention embracing the possibility to choose meaningful occupations. Occupational Therapists and other health professionals should address mobility when improving occupational performance in older adults.     

Sexual Orientation and Sexual and Reproductive Health Among Adolescent Young Women in the United States

PurposeWe studied sexual and reproductive health among self-identified bisexual, lesbian, and heterosexual adolescent young women. Prior research has suggested that bisexual and lesbian young women may be at greater risk for many negative health outcomes, including risky sexual and reproductive health behavior.MethodsUsing data from the U.S. nationally representative 2006–2010 National Survey of Family Growth (NSFG), we examined sexual and reproductive health among young women 15–20 years of age as a function of sexual orientation. We used logistic regression and ANCOVA to examine differences in sexual and reproductive health across groups while controlling for demographic group differences.ResultsBisexual and lesbian young women reported elevated sexual and reproductive health risks. Bisexual and lesbian participants reported being younger at heterosexual sexual debut, and having more male and female sexual partners, than did heterosexual participants. Further, they were more likely than heterosexual young women to report having been forced to have sex by a male partner. Bisexual young women reported the earliest sexual debut, highest numbers of male partners, greatest use of emergency contraception, and highest frequency of pregnancy termination.ConclusionsOverall, sexual minority young women—especially those who identified as bisexual—were at higher sexual and reproductive risk than their heterosexual peers.     

Women's Preferred Sources for Primary and Mental Health Care: Implications for Reproductive Health Providers

PurposeTo describe women's preferences for reproductive health providers as sources of primary and mental health care.MethodsThis is secondary data analysis of the Women's Health Care Experiences and Preferences Study, an Internet survey conducted in September 2013 of 1,078 women aged 18 to 55 randomly sampled from a U.S. national probability panel. We estimated women's preferred and usual sources of care (reproductive health providers, generalists, other) for various primary care and mental health care services using weighted statistics and multiple logistic regression.Main FindingsAmong women using health care in the past 5 years (n = 981), 88% received primary and/or mental health care, including a routine medical checkup (78%), urgent/acute (48%), chronic disease (27%), depression/anxiety (21%), stress (16%), and intimate partner violence (2%) visits. Of those, reproductive health providers were the source of checkup (14%), urgent/acute (3%), chronic disease (6%), depression/anxiety (6%), stress (11%), and intimate partner violence (3%) services. Preference for specific reproductive health-provided primary/mental health care services ranged from 7% to 20%. Among women having used primary/mental health care services (N = 894), more women (1%–17%) preferred than had received primary/mental health care from reproductive health providers. Nearly one-quarter (22%) identified reproductive health providers as their single most preferred source of care. Contraceptive use was the strongest predictor of preference for reproductive health-provided primary/mental health care (odds ratios range, 2.11–3.30).ConclusionsReproductive health providers are the sole source of health care for a substantial proportion of reproductive-aged women—the same groups at risk for unmet primary and mental health care needs. Findings have implications for reproductive health providers' role in comprehensive women's health care provision and potentially for informing patient-centered, integrated models of care in current health systems.     

Anthropology in Agricultural Health and Safety Research and Intervention

ABSTRACT

Agriculture remains a dangerous industry, even as agricultural science and technology continue to advance. Research that goes beyond technological changes to address safety culture and policy are needed to improve health and safety in agriculture. In this commentary, I consider the potential for anthropology to contribute to agricultural health and safety research by addressing three aims: (1) I briefly consider what the articles in this issue of the Journal of Agromedicine say about anthropologists in agricultural health and safety; (2) I discuss what anthropologists can add to agricultural health and safety research; and (3) I examine ways in which anthropologists can participate in agricultural health and safety research. In using their traditions of rigorous field research to understand how those working in agriculture perceive and interpret factors affecting occupational health and safety (their “emic” perspective), and translating this perspective to improve the understanding of occupational health professionals and policy makers (an “etic” perspective), anthropologists can expose myths that limit improvements in agricultural health and safety. Addressing significant questions, working with the most vulnerable agricultural communities, and being outside establishment agriculture provide anthropologists with the opportunity to improve health and safety policy and regulation in agriculture.     

Australian federal,state and territory policy on the health and wellbeing of young people: A scoping review

BackgroundThe health and wellbeing of young people are critical for the future of society but the extent to which they are addressed by overarching Australian Federal, State and Territory health policy is difficult to determine. Analysing high-level youth health policy will help establish how Australian governments are articulating and prioritising issues and may guide local and international health agendas.MethodsThis scoping review aimed to determine the extent, range and nature of Australian high-level government policy focused on the general health and wellbeing of the general population of young people. Policies published by Australian Federal, State, or Territory government departments between 2008 and 2019 were thematically analysed employing Braun and Clark's six-step recursive framework.FindingsTwelve policy documents met inclusion criteria. Three meta-themes emerged, comprising policy development, youth health challenges, and policy goals. Policy goals fell into three ubiquitous and overarching categories focused on supporting public health, promoting equity, and improving the health system for young people.ConclusionsA number of youth-specific health policies have been developed by Australian governments in recent years. Whilst goals and strategies are clearly articulated, more can be done to ensure a youth voice in policy development. The policy goals of supporting public health, promoting equity and improving the health system deserve consideration from other countries developing youth health policies.     

Analysis of Japanese occupational health services for small-scale enterprises, in comparison with the recommendations of the Joint WHO/ILO Task Group

Objectives: To evaluate Japanese occupational health services (OHSs) for small-scale enterprises (SSEs). Methods: The current Japanese OHSs for SSEs were compared with 15 recommendations of the Joint WHO/ILO Task Group. The status of OHSs was analyzed using the published papers collected by means of a computerized literature search. Thirty-five papers were used in the analysis, which was first conducted by the four authors separately, followed by discussion among the authors. Evaluation was conducted by classifying the status of Japanese OHSs for SSEs into three classes (A: good, B: average, C: poor) based on comparison with each recommendation. Results: Six issues were evaluated as “A”: establishment of a national policy for the provision of OHSs for SSEs, occupational health and safety inspection for SSEs, legislation to ensure services for SSEs and provision of financial incentives, adoption of occupational health programs using multiple channels, training in occupational health issues, and establishment of national data collection and registration systems. Nine issues were evaluated as “B”: provision of OHSs for all SSEs as a part of the “national Health for ALL” strategy, intervention combining economic development and OHSs, extension of OHSs to vulnerable groups, coverage of migrant and seasonal workers by OHSs, the establishment of a national collaborative and coordinative body on OHSs, control of transfer of hazardous technology, encouragement of applied research, employers' commitment and worker participation, and integration of OHSs with primary health care. None of them was evaluated as “C”. Conclusions: Japanese OHSs for SSEs were fairly well established in terms of compliance with the recommendations of the Joint WHO/ILO Task Group, although evaluation may be somewhat subjective and rather qualitative. Received: 08 September 1999 / Accepted: 31 January 2000     

Using Service-Learning to Teach Mental Health and Research Skills

ABSTRACT

This paper describes how an occupational therapy program used service-learning to integrate the learning objectives for mental health and research curriculum content. The service-learning program assisted participants diagnosed with mental illness to achieve success in higher education and/or related goals and served as a clinical program within a research curriculum for entry-level graduate occupational therapy students. The occupational therapy students served as mentors for the participants. The purpose of the program for the occupational therapy students was to teach research skills, clinical skills, and increase comfort in working with the mental health population. Seventy-eight occupational therapy students participated in the program over four academic years. A case example of a student/participant mentoring relationship is provided. Results indicated that the occupational therapy students gained comfort with the population and competence in their clinical and research skills.     

Knowledge,attitudes, and practices regarding hepatitis B vaccination among hospital-based doctors and nurses in China: Results of a multi-site survey

BackgroundHepatitis B virus (HBV) can cause chronic HBV infection, which may lead to advanced cirrhosis and liver cancer. Healthcare workers (HCWs) are at risk HBV infection as an occupational hazard. Hepatitis B vaccination of HCWs is recommended by WHO, but the status of hepatitis B vaccination among HCWs in China is seldom reported.MethodologyWe conducted a cross-sectional study in 22 hospitals of 3 developed cities in China. We interviewed managers in infectious diseases and occupational health departments, and at least 40 HCWs per hospital.ResultsWe interviewed 929 HCWs; 80.8% were vaccinated against hepatitis B and 96.7% were willing to be vaccinated; 38.2% of HCWs reported having at least one needle stick or sharps injury. Three hospitals provide free hepatitis B vaccination for HCWs; hospitals with a hepatitis B vaccination policy, more HCWs reported being vaccinated (91.7% vs 79.0%, P < 0.001). HCWs in high risk departments (P = 0.011), with more knowledge of hepatitis B vaccine (P < 0.001), and with fewer working years (P = 0.002) were more likely to be vaccinated against HBV. Infectious diseases and occupational health managers had positive attitudes towards hepatitis B vaccination.ConclusionsHepatitis B vaccination was well accepted among HCWs. Hospital provision of free vaccine, greater HCW knowledge of HBV, and working in higher-risk settings were associated with being vaccinated. A national policy of offering hepatitis B vaccine to HCWs should be considered in China. Provision of free hepatitis B vaccine for HBsAb negative HCWs may be acceptable. Education about HBV and hepatitis B vaccine may help promote policy implementation.     

The myth of participation in occupational therapy: reconceptualizing a client-centred approach

Abstract

Participation is often the comprehensive objective of treatment but also an indication of the extent to which the process of occupational therapy is client-centred. The purpose of this study was to explore levels of participation during occupational therapy among clients in the area of mental health from the occupational therapists' perspectives. Additionally the authors sought to identify factors that might hinder client participation. Postal questionnaires were sent out to 670 Swedish occupational therapists working with persons with mental illness and learning disabilities. The questionnaire required therapists to rate clients' levels of participation during occupational therapy. Findings indicated that the most common level of participation for the clients was interdependent, meaning that problems, goals, and plans were identified jointly and collaboratively with the occupational therapist. However, more than 20% of the clients were described as being dependent. Almost 90% of the occupational therapists rated client participation in therapy to be very important and nearly 70% claimed that client participation in general needed to be increased. Occupational therapists rated the primary barriers to participation as being clients' inability to participate and organizational and financial problems. Implications of these findings for education in client-centred practice approaches are discussed.     

Measuring improvement in knowledge of drug policy reforms following a police education program in Tijuana,Mexico

Background

Mexico’s 2009 “narcomenudeo reform” decriminalized small amounts of drugs, shifting some drug law enforcement to the states and mandating drug treatment diversion instead of incarceration. Data from Tijuana suggested limited implementation of this harm reduction-oriented policy. We studied whether a police education program (PEP) improved officers’ drug and syringe policy knowledge, and aimed to identify participant characteristics associated with improvement of drug policy knowledge.

Methods

Pre- and post-training surveys were self-administered by municipal police officers to measure legal knowledge. Training impact was assessed through matched paired nominal data using McNemar’s tests. Multivariable logistic regression was used to identify predictors of improved legal knowledge, as measured by officers’ ability to identify conceptual legal provisions related to syringe possession and thresholds of drugs covered under the reform.

Results

Of 1750 respondents comparing pre- versus post training, officers reported significant improvement (p < 0.001) in their technical understanding of syringe possession (56 to 91%) and drug amounts decriminalized, including marijuana (9 to 52%), heroin (8 to 71%), and methamphetamine (7 to 70%). The training was associated with even greater success in improving conceptual legal knowledge for syringe possession (67 to 96%) (p < 0.001), marijuana (16 to 91%), heroin (11 to 91%), and methamphetamine (11 to 89%). In multivariable modeling, those with at least a high school education were more likely to exhibit improvement of conceptual legal knowledge of syringe possession (adjusted odds ratio [aOR] 2.6, 95% CI 1.4–3.2) and decriminalization for heroin (aOR 2.7, 95% CI 1.3–4.3), methamphetamine (aOR 2.2, 95% CI 1.4–3.2), and marijuana (aOR 2.5, 95% CI 1.6–4).

Conclusions

Drug policy reform is often necessary, but not sufficient to achieve public health goals because of gaps in translating formal laws to policing practice. To close such gaps, PEP initiatives bundling occupational safety information with relevant legal content demonstrate clear promise. Our findings underscore additional efforts needed to raise technical knowledge of the law among personnel tasked with its enforcement. Police professionalization, including minimum educational standards, appear critical for aligning policing with harm reduction goals.

     

Women Connect! Strengthening Communications to Meet Sexual and Reproductive Health Challenges

ABSTRACT

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.     

某钢铁企业女职工生殖健康状况及需求调查

目的 了解钢铁企业女职工生殖健康状况, 以及她们对国家女职工劳动保护政策和生殖健康知识的知晓情况, 以保障和促进女职工生殖健康。
方法 采用横断面调查的方法, 选取某钢铁企业机关后勤和五个主要生产部门2 120名女职工作为研究对象。对女职工进行妇科体检, 发放调查问卷, 内容涉及对国家女职工劳动保护政策的了解、自身岗位接触有毒有害因素的知晓、对生殖健康知识的了解和需求。体检包括妇科常规检查、乳腺检查、白带检查、妇科B超和液基薄层细胞学检查。
结果 本次实检1 790人, 总受检率为84.43%。妇科检查发现乳腺小叶增生(检出率61.56%)、宫颈炎(检出率36.20%)和子宫肌瘤(检出率24.69%)是女性的多发妇科疾病, 乳腺小叶增生、子宫肌瘤的检出率有随年龄增高而增高的趋势(P < 0.05), 宫颈炎的检出率有随年龄增高而降低的趋势(P < 0.05)。接触职业病危害因素的生产部门女职工妇科体检的各项阳性率均高于机关后勤女职工, 其中乳腺小叶增生、子宫肌瘤、宫颈炎、阴道炎检出率的差异有统计学意义(P < 0.05)。液基薄层细胞学检查阳性率为4.70%。超过一半(占56.87%)的女职工知晓自身岗位的职业病危害因素, 但对国家有关劳动保护法律法规和女职工应享有的基本权利知晓率不高。女职工对本年龄段妇科常见病关注度较高, 基本在70%以上。49.16%的女职工选择手机网络获得生殖健康有关的知识。
结论 接触职业病危害因素会对女职工的生殖健康产生不利影响, 该企业女职工对国家有关女职工劳动保护法律法规了解不够。企业应加强相关法律法规培训, 根据不同年龄段的女职工需求, 普及生殖保健知识, 定期进行常规妇科疾病的普查, 切实保障女职工的生殖健康。
     

Public health, prevention and federalism: insights from the implementation of the federal law on health insurance

Summary Public health, prevention and federalism: insights from the implementation of the federal law on health insuranceObjetives:In 1996, the new Swiss law on health care insurance (KVG) introduced the coverage of certain preventive measures. This provided an opportunity to include research-based public health issues in federal health policy. The present article examines the problems with which the realization of those goals in a federalist health care system with strong cantonal autonomy as it is found in Switzerland was confronted.Method:Comparative qualitative case studies design (vaccination of school age children and screening-mammography).Results:Switzerlands federalist health care system strongly hinders the realisation of the Confederations public health goals. Prevention falls into the cantons autonomy and the federal KVG (Krankenversicherungsgesetz; Health insurance law) only regulates the coverage of the services provided, but does not contain any instruments to assure implementation in consistency with the policy goals. Under those circumstances, conflicts of interest between the implementing actors, varying cantonal preferences, and scarce resources block the implementation of public health goals.Conclusions:The results imply stronger leadership of the Confederation in prevention policy and an improved consideration of implementation aspects in approving new measures to obligatory insurance coverage.

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Public Health, Prävention und Föderalismus: Erkenntnisse aus der Umsetzung des Bundesgesetzes über die Krankenversicherung