Joining and leaving sex work: experiences of women in Kigali,Rwanda

Although sex work can bring significant economic benefit there are serious downsides, not least vulnerability to adverse sexual health outcomes. Focus-groups discussions and in-depth interviews were conducted with 70 female sex workers to explore the context in which they started sex work, their motivations to leave, and their experiences of trying to leave. The pathway to becoming a sex worker was underscored by poverty, with disruptive events leading to increasing vulnerability and increasingly difficult life choices. A sizeable minority of women became sex workers while working as house-girls, a position associated with financial, physical and sexual vulnerability. The majority of participants were still working as sex workers, citing financial reasons for not leaving. Motivations to leave sex work included experiencing a frightening incident, peer pressure and concerns about dependent children. Those who left often described a change in their financial circumstances that enabled them to leave. Some had left but had returned to sex work following a financial crisis or because they found their new life too hard. House-girls are particularly vulnerable and therefore an appropriate focus for prevention. Programmes assisting women to leave need to include financial safety nets so that a time of financial difficulty does not necessitate a return to sex work.     

Health-illness transition experiences among Mexican immigrant women with diabetes

Multiple and complex health-illness transitions are required for successful diabetes self-management. Diabetes health-illness transitions influence the daily lives and interactions of Mexican immigrant women with diabetes. This article reports the findings from an intervention study designed to facilitate the health-illness transition in Mexican immigrant women with type 2 diabetes who reside in the Arizona-Sonora region of the US-Mexico border. There was a significant (P<0.001) increase from preintervention to postintervention in diabetes knowledge and diabetes self-efficacy and a significant decrease (P 相似文献   

Pregnancy and antenatal care: the attitudes and experiences of Asian women

Asian women living in the East End of London were interviewed in English or in their own language to assess their attitudes to and experiences of pregnancy and antenatal care and to consider some factors which may influence their experiences, especially their fluency in English. In some respects Asian women's experiences were similar to those of non-Asian women reported in other studies, e.g. similar levels of nausea and lack of tie-up between nausea and negative reactions to pregnancy. However there were also some differences, e.g. Asian women expressed greater concern about the sex of the child and about eating 'cool' foods to counterbalance the hot state of pregnancy. Asian women were good patients: they attended antenatal clinics, read the leaflets provided and about half attended antenatal classes, although some were keener than others to seek information about pregnancy and childbirth and only a quarter bought books or watched videos. Less than half of the women were living in extended families and receiving support from in-laws in the traditional way. Those living in nuclear families received support from friends, neighbours and especially husbands. There were considerable individual differences in women's reactions and experiences. Women who spoke little or no English were less knowledgeable and had lived for a shorter time in the UK than women who were fluent in English. Leaflets in languages women can read and link workers at clinics helped some women.     

Multidisciplinary diabetes team care: the experiences of young adults with Type 1 diabetes

Background

This research examined whether young adults with Type 1 diabetes engage with the multidisciplinary consultation process and if not, then why.

Methods

We designed a web‐based self‐reported survey, available online from February to May 2011, for Australian adults 18–35 years with Type 1 diabetes. Respondents were asked about which clinicians they consulted to assist with self‐management. To expand on the results of the survey, we interviewed 33 respondents.

Results

Survey: Respondents (n = 150) consulted with the following clinicians: endocrinologist and diabetes educators: 23.3%; endocrinologist only: 18.0%; endocrinologist, diabetes educators and dieticians: 14.6%; endocrinologist, diabetes educators, dietician and general practitioners (GP): 11.3%; endocrinologist and GP: 10.6%; GP only: 4.6%; all clinicians recommended to assist with self‐management: 1.3%; 2.7% did not consult any clinician. Interview: Participants (n = 33) reported eight key disincentives to consultation with multidisciplinary clinicians. These were time constraints; provision of conflicting advice; inaccessibility of health services; variation in service standards; cost constraints; failure of clinicians to refer to other clinicians; lack of opportunity to build a therapeutic relationship; and failure of clinicians to engage in shared decision making.

Conclusion

Our results indicate that high attrition rates of young adults with Type 1 diabetes from recommended diabetes health services is linked to the failure of those services to meet the needs and preferences of their patients. The identified needs and preferences included joint consultation with multi‐disciplinary team clinicians; flexible access to advice by email or telephone consultation; and shared decision making. Patient engagement in health‐service re‐design has implications for improved health‐service delivery and enhanced treatment outcomes.     

Pregnancy experiences of women in rural Romania: understanding ethnic and socioeconomic disparities

Women in rural Romania face significant health disadvantages. This qualitative pilot study describes the structural disadvantage experienced during pregnancy by women in rural Romania, focusing on the lived experiences of Roma women. We explore how women in rural communities experience pregnancy, their interactions with the healthcare system, and the role that ethnic and social factors play in pregnancy and childbearing. We conducted 42 semi-structured interviews with health and other professionals, seven narrative interviews with Roma and non-Roma women and a focus group with Roma women. Data were analysed using thematic analysis. We identified intersectional factors associated with women’s pregnancy experiences: women perceiving pregnancy as both unplanned and wanted, joyful, and normal; women’s and professionals’ differing prenatal care perceptions; transport and cost related barriers to care; socioeconomic and ethnic discrimination; and facilitators to care such as social support, having a health mediator and having a doctor. Talking directly with professionals and Roma and non-Roma women helped us understand these many factors, how they are interconnected, and how we can work towards improving the pregnancy experiences of Roma women in rural Romania.     

Pregnancy, birth, and disability: women's health care experiences

This qualitative study examined the pregnancy, birth and postpartum experiences of 12 women with mobility-limiting physical disabilities. Analysis of semi-structured interviews of one to two hours revealed that the women's experiences were influenced by their own perspectives and the characteristics of health care system within which they were treated. The woman's experience included the effect of her disability, her resources, and her personality and approach. Health care system factors included provider attitudes, knowledge about disability and structural and political factors. Implications for health care providers are described.     

Pregnancy in women with diabetes mellitus type I: maternal and perinatal complications, in spite of good blood glucose control

OBJECTIVE: To examine the maternal and neonatal outcome of pregnancies of women with type I diabetes mellitus. DESIGN: Retrospective. METHODS: The medical records of pregnancies (> or = 16 weeks) in women with type I diabetes mellitus between 1986/'97 were studied in University Medical Center Utrecht, Academic Hospital Groningen and Isala Clinics, location 'De Weezenlanden', Zwolle, the Netherlands. RESULTS: During the study period, 172 women had 220 pregnancies: 212 single and 8 twin pregnancies. The mean age was 29.1 years (SD: 4.1), the mean duration of standing of the diabetes was 12 years (range: 1-32) and the mean concentration of glycosylated haemoglobin (HbA1c) was 6.3% at 10 weeks of pregnancy. The incidence of children with congenital malformations was 4 times higher (n = 19; 9.0%) than that in the Dutch population (2%). Macrosomia occurred in 92 children (43.4%) and perinatal mortality in 7 (3.3%). Maternal hypertensive complications occurred in 39 single pregnancies (18.4%), which is 2-3 times more often than in the Dutch population. CONCLUSION: In type I diabetic women maternal complications, perinatal morbidity and mortality are increased, despite near optimal glycaemic control.     

妊娠糖尿病患者妊娠相关焦虑及影响因素分析

目的 调查妊娠糖尿病患者妊娠相关焦虑现状及影响因素,为改善妊娠糖尿病患者的心理状况提供参考。方法 2017年1月-2017年6月,采用一般情况调查表、妊娠相关焦虑量表,易感人格类型问卷、一般自我效能感量表、社会支持量表等对郑州市某三级综合医院产科门诊218例妊娠糖尿病患者进行妊娠相关焦虑及影响因素的调查研究。结果 妊娠糖尿病患者妊娠相关焦虑的阳性率为43.1％。多元逐步回归分析显示社会支持、自我效能、文化程度、家庭月收入是妊娠糖尿病患者妊娠相关焦虑的保护因素,易感人格、有不良妊娠史是妊娠糖尿病患者妊娠相关焦虑的危险因素,可解释妊娠相关焦虑43.3%的变异。结论 妊娠糖尿病患者妊娠相关焦虑发生较为普遍,影响患者及胎儿健康,医务人员应根据妊娠相关焦虑的危险因素制定孕期心理保健措施。     

The hard work of self-management: Living with chronic knee pain

Self-management is a key policy initiative in many western countries, and most approaches are designed for people with long-term conditions based upon giving support and advice in order to manage the impact of the condition(s). Less attention has been paid to what people already do themselves. In this paper we focus on the meaning and enactment of self-management in everyday life and the hard work associated with devising and maintaining routine adaptive strategies. This UK-based qualitative study examined how people live with knee pain. From the interviews (22 at baseline, 15 at 6 months) and monthly diaries, it emerged that self-management could be based on implicit and incremental learning from experience or on explicit evaluation of actions. Either way, embodied and emotional hard work was involved in maintaining a daily life that allowed people to fulfil social roles and relationships. This individual and contextualised work needs to be recognised and drawn upon before specific self-management approaches are promoted.     

Group work: experiences of nursing students

This study aims at understanding the meaning attributed by undergraduate nursing students to the experience of group/team work. Based on the phenomenological framework. Individual interviews were conducted with nine students from the fourth year of the undergraduate program at the University of S?o Paulo at the Ribeir?o Preto College of Nursing. Later, these were analyzed according to Martins and Bicudo (1989). The following categories emerged: group work focused on subjects; group work experienced in the classroom; group work: relationship among students and among students and teachers; group work in the training field; are students prepared for group work? By taking into account that professional practice in healthcare has shown the need to be interdisciplinary and that academic education presents gaps, concerning the practice of group work, re-thinking about such education becomes relevant, since it will recover the understanding of complexity in human relations involving their political, institutional and interpersonal dimensions.     

Pregnancy,pregnancy loss and the risk of diabetes in Chinese women: findings from the China Kadoorie Biobank

European Journal of Epidemiology - Pregnancy and pregnancy loss may be associated with increased risk of diabetes in later life. However, the evidence is inconsistent and sparse, especially among...     

A national study of problematic care experiences among Latinos with diabetes

Despite the large disease burden of diabetes, little is known about the care experiences of Latinos with diabetes across diverse primary care settings. This study compares problematic care experiences among Latinos with diabetes across usual care sites (community health centers [CHCs], private physician practices, or without a usual source of care), using a national sample of Latino diabetic patients (N=583). Nearly half of the respondents reported at least one problematic care experience during their last clinician visit. Compared with respondents treated primarily by private physicians, respondents receiving care in CHCs or without a usual source of care reported more problematic care experiences. However, patient health insurance coverage and acculturation accounted for the highest proportion of explainable differences in problematic care experiences between CHCs and private physician offices. Initiatives should clarify the extent to which the care experiences of Latino diabetics, particularly uninsured and less acculturated patients who tend to be cared for by CHCs, can be improved through clinician communication and patient self-management interventions.     

1型糖尿病青春期女性的卵巢功能

胰岛素对碳水化合物代谢方面的作用众所周知,其对调节卵巢功能同样起着很重要的作用.卵巢卵泡膜细胞、颗粒细胞和间质细胞可能受到胰岛素缺陷或胰岛素过多的影响,其可能出现在1型糖尿病女性中.即使积极应用胰岛素进行治疗,在1型糖尿病女性中仍会被观察到乳房初发育、阴毛初现和月经初潮的年龄有所延迟.另外,卵巢高雄激素血症可能在青春晚期出现,多毛和多囊卵巢综合征在1型糖尿病成年女性中发生率有所增加.这些内分泌异常可能与非生理性的胰岛素替代治疗和高血糖水平有关.该文对1型糖尿病青春期女性发育和生殖方面的异常进行了综述,揭示了临床上青春期延迟、月经紊乱和高雄激素血症等可能最终导致一些患者成年后出现多囊卵巢综合征的重要问题.