Integrated women’s health program

ConclusionThe program design and implementation resulted in an improved comprehensive women’s health training experience for residents, which was integrated into a family medicine context. Ongoing evaluation and innovation will serve to continually improve this program.     

Depression in women’s magazines

BackgroundMass communication research suggests that the media influence both what a population thinks about and how it thinks about an event or situation by controlling what is covered and how topics are framed. One medium, popular women’s magazines, has published depression-related articles for decades. However, little is known about the content and frame of these articles.ObjectiveThe research sought to determine what women’s magazines published about depression between 1980 and 2000.DesignArticles published on depression in the top eight circulating women’s magazines, between 1980 to 1985 and 1995 to 2000 were retrieved and analyzed using qualitative media analysis methodology.ResultsBetween the two periods, the magazines increased the number of published articles on depression and increasingly framed it as a treatable but stigmatized illness.ConclusionWomen’s magazines, which regularly publish information on depression, have high circulation rates, resulting in millions of exposures to their messages. Psychiatric nurse-authors have an opportunity to influence these messages.     

“The complaining women”: health professionals’ perceptions on patients with fibromyalgia in Spain

Purpose: The aim of this study is twofold: (1) to explore health service providers’ perceptions regarding fibromyalgia patients in Spain and (2) to analyze possible consequences of these perceptions in terms of how health service providers construct the disease and treat their patients.

Design: Qualitative study.

Subjects/Patients: Twelve health service providers (eight men, four women) involved in the care of fibromyalgia patients. Providers were from different disciplines and included general practitioners, rheumatologists, occupational doctors, psychologists, psychiatrists, physiotherapists and behavioral specialists from Spain.

Method: We performed individual semistructured interviews, which were recorded and transcribed to conduct a qualitative content analysis supported by Atlas.ti-7.

Results: We identified three categories from the interviews: (1) the fibromyalgia patient prototype: the complaining woman, (2) fibromyalgia is considered a women’s health issue, but male patients are a privileged minority, and (3) health professionals’ attitudes toward fibromyalgia patients: are they really suffering or pretending?

Conclusion: The uncertainty surrounding fibromyalgia together with the fact that those affected are primarily women, seem to influence professional practice in terms of lack of recognition of Fibromyalgia as a severe disease. Increased training of all health professionals is essential to improving the support and attention given to patients suffering from fibromyalgia.

• Implications for rehabilitation

• Fibromyalgia

• ??In order to improve fibromyalgia patients´ attention, health providers should learn how to assist patients without prejudices.

• ??Training programs for health providers should include sensitization about the severity of fibromyalgia.

• ??Health providers should be aware of the existence of stereotypes about women suffering from fibromyalgia.

• ??Fibromyalgia protocols should give skills to health providers to avoid offering a gender-biased attention to patients.

     

Migraine – more than a headache: women’s experiences of living with migraine

Purpose: In this qualitative study the aim was to explore the meaning of living with migraine. Methods: In-depth interviews were conducted with ten women about their experience of living with migraine. Halfway through the interview, the women drew a picture of what living with migraine is like, and the interview continued with the conversation being guided by the picture. The interviews were analyzed using a hermeneutic phenomenological method inspired by van Manen. Results: The analysis revealed an essence “Being obliged to endure a life accompanied by an unpredictable and invisible disorder” and three themes “Being besieged by an attack”, “Struggling in a life characterized by uncertainty” and “Living with an invisible disorder.” Conclusions: Migraine is a debilitating disorder which accompanies life in the sense that it or the threat of its return is always present, and yet invisible to others. The struggle of enduring life with migraine is worsened by the feeling of having an invisible disorder and of being doubted. There is a need to increase the knowledge among healthcare professionals about what it means to live with migraine, something this qualitative study offers.

Implications for Rehabilitation

• The meaning of living with migraine is experienced as having a debilitating disorder which accompanies life in the sense that it or the threat of its return is always present, and yet invisible to others.

• There is a need for healthcare professionals to increase their awareness of the meaning of living with migraine, to enable them to meet the needs of each person with migraine.

     

Men’s health: time for a new approach

Background: Many men’s health outcomes are poor at the global level. Men have lower life and healthy life expectancies than women. They are more likely to die from cancer, cardiovascular disease, suicide, road traffic accidents and other major causes of death. They are more likely to smoke, drink alcohol excessively and eat a poor diet. In many countries and for many diseases, men use primary care services less effectively than women.

Objectives: The purpose of this article was to review the key data on men's health at the global level and explore explanations for men's outcomes, including health practices, use of services and health literacy and masculinities. The response of health organisations, the evidence of the impact of gender-sensitive interventions and the case for action on men's health were also considered.

Major findings: Despite the problems with men’s health, it has been largely overlooked by national and global health organisations. When organisations do focus on gender, action is usually targeted at women and girls rather than both sexes. There is an increasing body of evidence that sex-specific initiatives can also be effective.

Conclusions: If population health is to be improved, and if good health is a universal right, steps must be taken to improve men’s health as well as women’s. There is a role for male-targeted health policies (building on the lessons of national men’s health policies in Ireland, Brazil and Australia) as well as changes to service delivery. There is not a choice to be made between men’s health and women’s health: this need not be a zero sum game. Action is needed for both sexes and improving the health of men will also improve the health of women.     

Nurse practitioner (NP) led care: Cervical screening practices and experiences of women attending a women’s health centre

Background

Cervical cancer is the second most prevalent carcinoma among women. Stringent screening is the most effective strategy of reducing the morbidity and mortality associated with cervical cancer, however barriers to such screening exist. South West Sydney is primarily populated by ethnic minority groups and those with lower socioeconomic status. Thus, women from this area of Sydney represent some of the most disadvantaged women and face many barriers when accessing healthcare, including cervical cancer screening. Previous research has found that gender can influence attitudes and practices regarding women’s health screening. While women’s health nurse practitioners are becoming more involved in preventative healthcare including cervical cancer screening, the experiences of women who access their services have not been explored.

Generational differences in complementary medicine use in young Australian women: Repeated cross-sectional dataset analysis from the Australian longitudinal study on women’s health

ObjectiveExamine the generational differences in complementary medicine (CM) utilisation between young women from the X and Millennial generations.DesignSecondary analysis of two cross-sectional surveys from the Australian Longitudinal Study on Women’s Health (ALSWH).SettingAustralia.Main outcome measuresDifferences between young Generation X women (surveyed 1996; aged 18–23 years), and Millennial women (surveyed 2014; aged 19–24 years) regarding consultations with CM practitioners, sociodemographic characteristics, and health. Predictors for CM consultations were analysed via logistic regression analyses.ResultsOf the 14,247 Generation X women, 19.4% reported consulting CM, compared to 26.8% of the 11,344 Millennial women. CM consultations was predicted in both cohorts by higher age, education beyond primary school, non-urban (vs. urban) residence, and frequent back pain or headaches. Obesity and regular smoking predicted non-use in both. Significant cohort differences were found in physical activity levels (moderate/high levels associated with increased CM consultations in Millennial, but not Generation X women), and health status (Generation X women reporting fair-poor health were more likely to consult CM practitioners, while Millennial women reporting good health were less likely to do so, compared to women with very good/excellent health).ConclusionsThe increase in CM utilization among young Australian women from Generation X compared to the Millennial generation could indicate different health consumer patterns for future middle-aged and older adult Australian women. Further increases in CM usage may be observed as current young women age into characteristics traditionally linked with higher CM use such as worsening health status and increased disposable income.     

Australian nurses in general practice,enabling the provision of cervical screening and well women’s health care services: a qualitative study

Background

The role of Australian general practice nurses (PNs) has developed exponentially since the introduction of service based funding in 2005. In particular, their role has expanded to include cervical screening and well women’s health care services provided under the supervision of a general practitioner (GP). While previous research identifies barriers to the provision of these services, this study sought to investigate enablers for nurse led care in this area.

Methods

A number of grounded theory methods including constantly comparing data, concurrent data collection and analysis and theoretical sampling are utilised in this qualitative, exploratory study. A purposive sample of PNs who completed the required program of education in order to provide cervical screening and well women’s health care services was recruited to the study. Data is presented in categories, however a limitation of the study is that a fully integrated grounded theory was unable to be produced due to sampling constraints.

Results

Four enablers for the implementation of a change in the PN role to include cervical screening and well women’s health checks are identified in this study. These enablers are: GPs being willing to relinquish the role of cervical screener and well women’s health service provider; PNs being willing to expand their role to include cervical screening and well women’s health services; clients preferring a female practice nurse to meet their cervical screening and well women’s health needs; and the presence of a culture that fosters interprofessional teamwork. Seven strategies for successfully implementing change from the perspective of PNs are also constructed from the data. This study additionally highlights the lack of feedback on smear quality provided to PNs cervical screeners and well women’s health service providers.

Conclusions

The influence of consumers on the landscape of primary care service delivery in Australia is of particular note in this study. Developing interprofessional teams that maximise each health care provider’s role will be fundamental to comprehensive service delivery in the future.

     

Bone marrow necrosis in a girl with Hodgkin’s disease

Bone marrow necrosis (BMN) is a rare finding in children with malignancy occurring most commonly in children with acute lymphoblastic leukemia. This article describes the first case of a girl who developed BMN during treatment for Hodgkin's disease. During the second cycle of chemotherapy, she experienced sudden profound bone pain in the lumbosacral region associated with elevated levels of lactate dehydrogenase (LDH), fibrin degradation products (D-Dimer), and alkaline phosphatase as well as pancytopenia and leukoerythroblastosis. MRI studies showed multiple confluent areas with low signal intensity and rim contrast enhancement in all vertebral bodies. Bone marrow biopsy revealed focal necrosis within hypocellular bone marrow. The patient responded quickly to symptomatic treatment with analgetics and heparin; however, elevations of LDH and D-Dimer persisted for 1.5 and 8?months, respectively. Clinicians should be aware of this rare condition to establish the diagnosis and to continue oncologic treatment as early as possible.     

Comparison of thromboelastometry by ROTEM® Delta and ROTEM® Sigma in women with postpartum haemorrhage

Haemostatic treatment in women experiencing postpartum haemorrhage is increasingly based on point-of-care devices such as ROTEM^® thromboelastometry. Recently, a fully automated successor of the ROTEM^® Delta device, the ROTEM^® Sigma was introduced. To determine whether these devices provide similar results, we compared ROTEM^® parameters using the ROTEM^® Delta and Sigma devices in women experiencing postpartum haemorrhage. Prospective observational cohort study of 23 women experiencing postpartum haemorrhage. ROTEM^® INTEM, EXTEM, FIBTEM and APTEM measurements handled by the ROTEM^® Delta and Sigma devices were compared. ROTEM^® FIBTEM values were also related to Clauss fibrinogen values. A correlation of Spearman’s r (r_s) varying between 0.76 and 0.95 was displayed between clot firmness measured in millimeters at 5 (A5), 10 (A10) and 20 (A20) minutes after start of clot formation measured by EXTEM, INTEM and APTEM assays executed on both devices; A5, A10 and A20 of FIBTEM correlated less well (r_S between 0.71 and 0.74), especially after five and ten minutes. Correlation between both devices regarding clotting time (CT) was poor. The observed correlation between levels of Clauss fibrinogen and FIBTEM A5 was r_s = 0.70, (95% confidence interval (CI): 0.38 to 0.87) for Delta and r_s = 0.85, (CI 0.65 to 0.94) for Sigma. A5, A10 and A20 measured in EXTEM, INTEM and APTEM obtained from ROTEM^® Delta and Sigma devices were similar. EXTEM, FIBTEM and APTEM CT values from both devices showed no correlation. Substantial variation was found between FIBTEM assays of the devices. Consequently, results of FIBTEM assays should always be interpreted in the context of device-specific reference values. Correlation with Clauss fibrinogen was better in the ROTEM^® Sigma device.     

Living with a powered wheelchair: exploring children’s and young people’s experiences

Purpose: The study aimed to explore the lived experiences of children and young people who use an Electric Powered Indoor/Outdoor wheelchair (EPIOC). Method: To allow for the individual lived experiences of the children to be explored, an exploratory study was designed using Interpretative Phenomenological Analysis (IPA). Nine children aged 7–16 years were recruited and their views explored through semi-structured interviews. Results: Children appeared to be working to achieve an adequate fit between self, the EPIOC and the environment. Where an adequate fit was achieved the child experienced positive consequences of using an EPIOC including increased participation and positive feelings. However an inadequate fit led to negative experiences including reduced participation, fear and anxiety. The changing interface between self, EPIOC and environment appeared to be important in shaping these experiences. Conclusions: This study adds to understanding the ambiguous experience of being a child EPIOC user and the need for ongoing support from services especially around stages of transition. It also contributes to the development of the social model of disability from a child’s perspective.

• Implications for Rehabilitation

• Children who use Electric Powered Indoor/Outdoor Chairs have both positive and negative experiences which are dependent on the fit of the child, chair and the environment.

• Child EPIOC users are active agents in shaping their experiences.

• Children who use an EPIOC maybe particularly at risk of reduced participation, especially at times when their environment changes significantly such as when leaving school or college.