Women’s experiences with immediate postpartum intrauterine device insertion: a mixed-methods study

Objective

To describe women's pain and experiences with immediate postpartum intrauterine device (IUD) insertion (IPPI) following vaginal delivery using a ring forceps insertion technique.

The abortion pill: a solution for unsafe abortions in developing countries?

The abortion pill is a new abortion technique which does not require technically skilled health personnel. Several clinical researchers have stated that the ease of administration of the abortion pill gives it the potential to save lives in countries where thousands of women die annually from complications of failed abortions due to poor health services. This article discusses medical and users' aspects of the abortion pill, with particular emphasis on its use in developing countries, and questions the usefulness of the abortion pill in areas where health care facilities are in short supply. It stresses the need to consider the social, cultural and health care context in which the abortion pill will be used before it is sold on the world market. The safety and efficacy of the abortion pill could be adversely affected by the way women perceive its effectiveness, women's beliefs about conception and pregnancy, and their health status. In the present two-phase administration form the abortion pill is not likely to be appropriate for use in developing countries with a shortage of health care facilities.     

Perforation with the GyneFix intrauterine implant: is there a common factor?

This report describes an asymptomatic perforation with the GyneFix intrauterine contraceptive implant. A review of all other reports of this complication has been performed. Analysis of these reports suggests prolonged amenorrhoea secondary to continuous progestogen use as a possible common predisposing factor.     

Is the crime drop of the 1990s in Canada and the USA associated with a general decline in risky and health-related behavior?

Crime rates dropped unexpectedly and dramatically in the 1990s in Canada and the USA. The decline was not restricted to particular types of crime, the particular methodologies of crime reports, demographic characteristics, or geographical areas. Psychological studies of individuals have suggested a link between crime and different types of risky behavior (e.g., dangerous driving, unsafe sex, substance use). Based on this link, we examined whether national rates of various risky behaviors declined in the 1990s, and whether rates of crime and risky behavior covary over time. Several American and Canadian databases reporting annual or biennial data on risky behavior indicators were examined. Results indicate that most of the risky behavior indicators in the domains of violent behavior, accidents, sexual behavior, and school dropout declined in the 1990s. Furthermore, time series analyses suggest that rates of various risky behaviors tend to covary with homicide over long periods of time. An important exception to these results is substance use in various contexts. We discuss some theoretical implications of the results.     

Training to fit intrauterine devices/intrauterine systems for general practitioners: is there an alternative method of service delivery?

BACKGROUND AND METHODOLOGY: This paper questions the traditional method of obtaining intrauterine device (IUD) and intrauterine system (IUS) training, by highlighting the pitfalls of this training, and introduces community IUD/IUS training, a new model offering significant advantages. Discussion and conclusions: Traditional IUD/IUS training is not optimal for a variety of reasons including scarcity of designated IUD/IUS clinics, long distances for travel to be trained, wasted clinic appointments, a tendency towards difficult IUD/IUS fitting in these specialist clinics, and a lack of suitable doctors as IUD/IUS trainers. Community IUD/IUS training enables the trainee to be involved in patient selection, setting up an IUD/IUS clinic (probably for their own future use) and following up their own patients. Community IUD/IUS fitting has definite advantages and much to commend it.     

Preventing a Non-Existent Illness?: Some Issues in the Prevention of “Schizophrenia”

The prevention of schizophrenia has received little attention, not least because it is claimed that its causes are largely unknown. I argue that this pessimistic view is based on acceptance of both the highly problematic concept of schizophrenia and of the assumption that it is a genetic/biological illness. The problems of both the concept and its surrounding assumptions are examined and an alternative model of psychotic behaviour and experience, with very different implications for prevention, is discussed.     

Changing tactics in the abortion argument: does a fetus feel pain?

The 30th anniversary of the passing of the abortion law in England sparked off yet another skirmish in the continuing struggle. Not only the Catholic Church but also anti-lobby groups have protested against the abortion law. Anti-lobby groups consider abortion as an evil that must be fought. To further explain their point, the anti-lobby groups used the conclusions on pediatric anesthetic practice to change their tactics in combating the abortion issue from the emotional point of view to the apparently rational. A group of pediatricians, anesthetists, bioethicists and neuroanatomists has considered the problem of when the fetus may first be able to feel pain. They have decided that the fetus cannot feel pain before the 26th week and recommended that the fetus be given an anesthetic for any abortion later than the 24th week. The anti-lobby groups say that this view limits the perception of pain to the cerebral cortex and that the thalamus is well enough developed by the 10th week for the growing embryo to feel the pain. However, as to the question of fetal pain, one can never know whether fetuses feel pain, because they can never tell.     

Mainstream media and the social determinants of health in Canada: is it time to call it a day?

This article explores the dearth of coverage of the social determinants of health by the Canadian mainstream media. It is argued that this neglect is primarily a reflection of political and economic societal structures that has been associated with increasing corporate control of the mainstream media. Applying a critical political economy lens, it is argued that the barriers to having the Canadian mainstream media report on the social determinants of health are so numerous that it may indeed be 'time to call it a day' in regard to having them assist in the dissemination of social determinants of health findings. Recognizing this reality should spur the development of alternative means of communicating with the public in order to develop a citizens' movement to create health-promoting public policy. Recent dissemination efforts related to the Social Determinants of Health: The Canadian Facts provide an example of how this might be accomplished.     

Resident characteristics associated with mortality in long-term care nursing homes: is there a gender difference?

OBJECTIVE: To examine the gender-specific association between characteristics in established long-term care residents and 1-year risk of mortality. DESIGN: A retrospective cohort study. SETTING: The Hebrew Rehabilitation Center for Aged, a 725-bed long-term care facility in Boston, Massachusetts. The 778 participants included 188 men (24%) and 590 women (76%). MEASUREMENTS: Minimum Data Set (MDS) information, including items from the following sections: cognition, communication, psychosocial, functional, diseases, health conditions and medication use. RESULTS: Survival curves were significantly different for men and women (log rank test, P = 0.004). Based on proportional hazards analyses, increased age, (RR(m)=1.07, RR(w)=1.05), functional impairment (RR(m)=1.07, RR(w)=1.04), and weight loss (RR(m)=2.03, RR(w)=2.24) were associated with increased mortality in men and women. Additionally, shortness of breath (RR = 2.87) and lower body mass index (RR = 2.25) were associated with higher mortality in men, and diabetes (RR = 2.42), pressure ulcers (RR = 1.99), anemia (RR = 1.98), congestive heart failure (RR = 1.87), and a recent fall (RR = 1.88) were associated with higher mortality in women. CONCLUSIONS: Characteristics associated with 1-year mortality differ between men and women. These readily available data could be useful in making medical decisions and advance directives planning. Furthermore, these data may be beneficial in developing quality improvement initiatives and mortality prediction modeling.     

What is it about intrauterine devices that women find unacceptable? Factors that make women non-users: a qualitative study

INTRODUCTION: There is a lack of published research into the perceptions of 'non-users' of copper intrauterine contraceptive devices (IUDs). Despite this being one of the most commonly used methods of contraception in other countries, only 5% of contraceptive users in Great Britain aged 16-49 years currently use an IUD. This study explores how women's lay beliefs and perceptions about IUDs lead to rejection of this contraceptive choice. METHODS: One-to-one semi-structured interviews were conducted with 10 women of varying ages and parity recruited from an urban general practice. None of the women had ever used IUDs but all had used contraception in the previous 6 months. Data were subjected to qualitative analysis. RESULTS: Five analytical themes were identified: lack of objective information about IUDs, reported side effects of IUDs, anxieties about the process of fitting an IUD, IUDs as an infection risk and lack of personal control of an IUD, once fitted. CONCLUSIONS: Some of the themes identified mirrored those found in studies of user attitudes to and experiences of IUDs. Others, particularly the prominent worries about mess and embarrassment during fitting and the association between the hidden nature of the fitted device and unreliability, are new and need wider exploration.     

Higher adherence to the Mediterranean diet is inversely associated with having hypertension: is low salt intake a mediating factor?

Blood pressure (BP) is a major risk factor for population health worldwide and a preventable disease through lifestyle modification. The aim of this study was to assess the association between adherence to the Mediterranean diet (MD) and occurrence of hypertension in a Mediterranean cohort. Demographic and dietary data of 1937 adults were collected in 2014–2015 from the general population of Catania, Sicily (Italy). Food frequency questionnaires and a MD adherence score were used to assess exposure variables. Higher adherence to the MD was inversely associated with hypertension. However, this association was no more significant after adjustment for sodium and potassium intake. These results suggest that salt may exert a mediating effect of high adherence to the MD towards hypertension.