Update on Syphilis for Women’s Health Nurses

After declining for many years, rates of syphilis in the United States are increasing. This article discusses possible reasons why women, and specifically pregnant women, are not getting tested properly. Lack of prenatal care, poor access to prenatal care, and improper prenatal care all have contributed to cases of congenital syphilis. Clinicians working in women’s health care can address this issue by taking accurate sexual histories, remaining open to sexual fluidity among their patients, ensuring they are up to date on appropriate syphilis testing guidelines, and routinely offering screening to any woman at risk. Syphilis is a treatable and preventable sexually transmitted infection, and nurses, advanced practice nurses, and midwives can significantly contribute to reversing the current trend.     

Health Care Providers’ Knowledge,Practices, and Barriers to Hepatitis Vaccination Guidelines

We administered an online survey to 400 health care providers (HCPs) to evaluate knowledge and self-reported practices regarding hepatitis A (HepA)/hepatitis B (HepB) vaccination. Most HCPs (73%) were familiar with the Advisory Committee on Immunization Practices; 89% and 90% reported adhering to the guidelines always/most of the time for HepA and HepB, respectively. Self-reported adherence to guidelines varied across specialties, with nurse practitioners reporting the highest adherence rate of 94%. Survey results, including perceived barriers, reasons for not stocking vaccines, and predictors of adherence to and familiarity with guidelines, may inform strategies to improve compliance with hepatitis vaccination recommendations.     

Young Women’s Experiences of Expected Health Behaviors During Pregnancy: The Importance of Emotional Support

Nurses require current information about popular complementary and alternative medicine for pediatric asthma. This integrative review searched scientific literature in PubMed and WEB of Science from 2004 to 2009 via key terms: asthma complementary medicine, nursing complementary pediatric asthma, asthma herbal, and herbal pediatric asthma. Nine journal articles met the inclusion criteria of containing data collection and analysis for biologically based therapies for pediatric asthma. Evidenced-based research on this focus topic is still in its initial stages. Two themes of maximizing the diet and augmenting conventional therapy with Traditional Chinese Medicine may serve as conduits of patient education.     

Women’s Reactions to Partner’s Ejaculation Problems

Ejaculation problems—too rapid, too slow, or absent—may be as ancient as man himself but less researched than erectile difficulties. This article gives attention at long last to the woman partner who struggles to understand and react to recurrence of the ejaculation dysfunction. Some women may be wrongly blamed while others may berate him for his inability to overcome the symptom. Today, it is essential to gain more knowledge with added understanding of how his partner is impacted if the ejaculation problem persists. There are usually two patients when a sexual problem presents.     

Depressive Symptoms,Antidepressant Use,and the Incidence of Diabetes in the Black Women’s Health Study

OBJECTIVE

To assess the relationship of depressive symptoms and use of antidepressants with incident type 2 diabetes in prospective data from a large cohort of U.S. African American women.

RESEARCH DESIGN AND METHODS

The Black Women’s Health Study (BWHS) is an ongoing prospective cohort study. We followed 35,898 women from 1999 through 2011 who were without a diagnosis of diabetes and who had completed the Center for Epidemiologic Studies Depression Scale (CES-D) in 1999. CES-D scores were categorized as <16, 16–22, 23–32, and ≥33, which reflected increasingly more depressive symptoms. We estimated incidence rate ratios (IRRs) and 95% CIs for incident diabetes using Cox proportional hazards models. The basic multivariable model included age, time period, family history of diabetes, and education. In further models, we controlled for lifestyle factors and BMI. We also assessed the association of antidepressant use with incident diabetes.

RESULTS

Over 12 years of follow-up, there were 3,372 incident diabetes cases. Relative to CES-D score <16, IRRs (95% CI) of diabetes for CES-D scores 16–22, 23–32, and ≥33 were 1.23 (1.12–1.35), 1.26 (1.12–1.41), and 1.45 (1.24–1.69), respectively, in the basic multivariate model. Multiple adjustment for lifestyle factors and BMI attenuated the IRRs to 1.11 (1.01–1.22), 1.08 (0.96–1.22), and 1.22 (1.04–1.43). The adjusted IRR for antidepressant use was 1.26 (1.11–1.43). Results were similar among obese women.

CONCLUSIONS

Both depressive symptoms and antidepressant use are associated with incident diabetes among African American women. These associations are mediated in part, but not entirely, through lifestyle factors and BMI.     

“Women … Mourn and Men Carry On”: African Women Storying Mourning Practices: A South African Example

African mourning of loss of lives in South Africa has been shaped by discursive practices of both traditional African cultures and the sociopolitical developments under apartheid and in post-apartheid South Africa. This article reports on changes in mourning practices on the basis of a literature review and uses a collection of examples to highlight the navigation of some cultural and gendered issues relating to mourning, against the backdrop of the everyday experiences of loss of life in South Africa due to violence and HIV/AIDS. The article draws on African womanist and feminist scholarship and focuses on the intersections between cultural and gender practices of bereavement in the lives of professional urban African women. The authors argue for the use of positioning theory and witnessing practices to honor and story the ongoing struggle of African women as these women take different agentic positions by accepting, questioning, resisting, and/or changing cultural mourning practices while they compassionately witness the self and others in the narratives they live.     

Health Promotion Practices in Two Chiropractic Teaching Clinics: Does a Review of Patient Files Reflect Advice on Health Promotion?

Purpose:

To retrospectively review patient files in two teaching clinics in the United States and to assess the documented attempts to deliver health promotion messages when a chart indicated a need for health promotion or a red-flag condition that could be helped with positive behavioral changes.

Methods:

Approximately 100 patient files were randomly selected from each of two separate chiropractic teaching clinics, for patients seen after January 2007. Files were assessed for pertinent family history of diseases, personal medical history, and red-flag conditions of patients that would warrant intervention with health promotion.

Results:

Health promotion advice on at least one occasion was noted in 108 (53.7%) patient charts. Only 7 of 98 overweight or obese patients and none of those with family history of obesity were advised on weight management. Among 23 hypertensive patients, only 5 were advised and 17 of the 97 patients with risk of cardiovascular disease were advised.

Conclusion:

Chiropractic teaching clinics should assess what they are doing to help Americans reach their health goals. There is an opportunity to shape future practitioners so they include primary prevention as a part of what they do if the profession cares to move in that direction. Future research should look at mechanisms of delivery for health promotion, including better tracking of patients who need it and how staff doctors are trained to deliver oversight to interns in the area of primary prevention.Key Indexing Terms: Cardiovascular System, Chiropractic, Health Promotion, Hypertension, Obesity     

Nurse Practitioners’ and Nurse Practitioner Students’ LGBT Health Perceptions

Nurse practitioner (NP) and NP student perceptions of adult lesbian, gay, bisexual, and transgender (LGBT) health needs were qualitatively explored. One overreaching theme, “We need to do better. We have a lot to do,” and four key themes were identified: (1) same basic health needs as straight people; (2) a little more risk, a little more help, a little extra care; (3) breaking down that trusting, honest provider relationship; and (4) society sucks and social media and politics play a major role. Results support the need for future research exploring NP and NP student understanding of LGBT health needs.     

Determinants of Racial/Ethnic Disparities in Incidence of Diabetes in Postmenopausal Women in the U.S.: The Women’s Health Initiative 1993–2009

OBJECTIVE

To examine determinants of racial/ethnic differences in diabetes incidence among postmenopausal women participating in the Women’s Health Initiative.

RESEARCH DESIGN AND METHODS

Data on race/ethnicity, baseline diabetes prevalence, and incident diabetes were obtained from 158,833 women recruited from 1993–1998 and followed through August 2009. The relationship between race/ethnicity, other potential risk factors, and the risk of incident diabetes was estimated using Cox proportional hazards models from which hazard ratios (HRs) and 95% CIs were computed.

RESULTS

Participants were aged 63 years on average at baseline. The racial/ethnic distribution was 84.1% non-Hispanic white, 9.2% non-Hispanic black, 4.1% Hispanic, and 2.6% Asian. After an average of 10.4 years of follow-up, compared with whites and adjusting for potential confounders, the HRs for incident diabetes were 1.55 for blacks (95% CI 1.47–1.63), 1.67 for Hispanics (1.54–1.81), and 1.86 for Asians (1.68–2.06). Whites, blacks, and Hispanics with all factors (i.e., weight, physical activity, dietary quality, and smoking) in the low-risk category had 60, 69, and 63% lower risk for incident diabetes. Although contributions of different risk factors varied slightly by race/ethnicity, most findings were similar across groups, and women who had both a healthy weight and were in the highest tertile of physical activity had less than one-third the risk of diabetes compared with obese and inactive women.

CONCLUSIONS

Despite large racial/ethnic differences in diabetes incidence, most variability could be attributed to lifestyle factors. Our findings show that the majority of diabetes cases are preventable, and risk reduction strategies can be effectively applied to all racial/ethnic groups.More than 25 million Americans have diabetes, and an estimated 300 million worldwide will be diagnosed with diabetes by the year 2025 (1,2). Diabetes is the seventh leading cause of death in the U.S. and is an underlying factor in cardiovascular and cancer mortality (1,3). Non-Hispanic blacks have been reported to be 1.4–2.2 times more likely to receive a diagnosis of diabetes than non-Hispanic whites in the U.S. population (4). U.S. women of Hispanic and Asian ancestry also have a higher prevalence of diabetes than non-Hispanic whites (5). Although racial/ethnic disparities in diabetes risk have been identified, determinants of these differences have not been well studied. Previous studies have considered dietary and lifestyle factors individually, but few studies have considered these factors in aggregate in order to estimate the proportion of diabetes that might be avoided by adopting a pattern of low-risk behaviors (6,7). Moreover, few studies have been large or diverse enough to allow for the assessment of these relationships in individual racial/ethnic groups, particularly among women.The Women''s Health Initiative (WHI) provides a unique opportunity to assess racial/ethnic disparities in both diabetes prevalence and incidence and factors contributing to disparities in diabetes incidence within a large and well-characterized group of postmenopausal women.     

‘Modelling a Secure-Base’ for Women with Complex Needs: Attachment-Based Interventions Used by Perinatal and Infant Mental Health Clinicians

Infant well-being is intrinsically linked to maternal physical and emotional well-being. Internationally health services have implemented policies to identify women at risk of mental health problems and developed effective care pathways. The aim of this paper is to describe how perinatal and infant mental health clinicians perceive their role and the attachment-based interventions they use in their work. The study comes from a larger mixed methods study, which examined two specialist perinatal and infant mental health services in New South Wales (Australia). Two hundred and forty-four medical records were reviewed, and six perinatal and infant mental health clinicians participated in in-depth semi-structured interviews. Data were analysed by content and thematic analysis. One overarching theme, modelling a secure base and three supporting themes, enhancing reflective capacity, enhancing emotional regulation and enhancing empathy emerged from the analysis. These findings demonstrate how perinatal and infant mental health clinicians use attachment theory to inform practice by modelling “holding” and being a secure-base for women. They also provide a clearer understanding of perinatal mental health practice and can be used to inform educational programs for multidisciplinary mental health professionals particularly those working with women and infants.