Making the invisible body visible. Bone scans, osteoporosis and women's bodily experiences

The imaging technology of bone scans allows visualization of the bone structure, and determination of a numerical value. Both these are subjected to professional interpretation according to medical (epidemiological) evidence to estimate the individual's risk of fractures. But when bodily experience is challenged by a visual diagnosis, what effect does this have on an individual? The aim of this study was to explore women's bodily experiences after a bone scan and to analyse how the scan affects women's self-awareness, sense of bodily identity and integrity. We interviewed 16 Danish women (aged 61-63) who had had a bone scan for osteoporosis. The analysis was based on Merleau-Ponty's perspective of perception as an embodied experience in which bodily experience is understood to be the existential ground of culture and self. Women appeared to take the scan literally and planned their lives accordingly. They appeared to believe that the 'pictures' revealed some truth in themselves. The information supplied by the scan fostered a new body image. The women interpreted the scan result (a mark on a curve) to mean bodily fragility which they incorporated into their bodily perception. The embodiment of this new body image produced new symptom interpretations and preventive actions, including caution. The result of the bone scan and its cultural interpretation triggered a reconstruction of the body self as weak with reduced capacity. Women's interpretation of the bone scan reorganized their lived space and time, and their relations with others and themselves. Technological information about osteoporosis appeared to leave most affected women more uncertain and restricted rather than empowered. The findings raise some fundamental questions concerning the use of medical technology for the prevention of asymptomatic disorders.     

GPs' perceptions of the role of DEXA scanning: an exploratory study

BACKGROUND: Current recommendation are that women with clinical indicators of low bone mineral density should be offered a DEXA (dual energy X-ray absorptiometer) scan to help assess the need for treatment, but little is known about GPs' attitudes towards DEXA scans. OBJECTIVE: Our aim was to explore GPs' beliefs about diagnosis and management of osteoporosis, including the role that DEXA scanning can play. METHODS: Semi-structured interviews with five GPs in the North Staffordshire area were used to explore how GPs make decisions about diagnosis and treatment of osteoporosis, including the use of scans and the application of potential clinical risk factors to decisions about screening and treatment. RESULTS: The decision-making process about whether and who to scan is complex and was influenced by a range of factors including issues of diagnosis, treatment, patient pressure and 'external' factors such as practice protocol and the perceived local availability of scans. CONCLUSIONS: GPs found it difficult to decide who and when to scan despite guidelines for primary care. Perceived local availability of DEXA scans is important and has implications for raising awareness.     

Consequences of surveying folate awareness

Objectives  To assess women's concerns when interviewed about the association between folate and neural tube defects (NTDs) and to determine how this is affected by time, being folate aware, having seen folate promotional material or being pregnant.
Design  As part of a community randomized trial outcomes evaluation, independent cross-sectional follow-up surveys were carried out in 1997 and 2000.
Setting and participants  Six local government areas in the state of Victoria, Australia; 2431 women aged between 15 and 44 years.
Main variables studied  Whether or not women knew of the association between folate and NTDs (i.e. were folate aware), whether or not women had been concerned by seeing folate/NTD information and if an interview about folate and NTDs had raised any concerns for them.
Results  In the 1997 survey, 36% of women said that the interview had raised concerns and this decreased to 26% in 2000. Women who were folate aware were significantly less likely to have raised concerns than women who were not folate aware (OR_adj= 0.38, 95% CI 0.24–0.60). In general, women who had seen promotional material were less likely to feel concern about the interview than those who had not, although this varied with whether or not the promotional material had raised concerns. These effects were greater in women who were pregnant.
Conclusions  Women had increased concerns having seen folate promotional material and after being interviewed about it. These results are consistent with the proposition that an initial emotional response to sensitive health information is part of an adaptive response appropriate to the process of health-related behaviour change.     

Knowing what to do: coping with sexual violence by male intimates

The purpose of the Heideggerian hermeneutical project, from which this article stems, was to describe women's experience of sexual violence by male intimates. Ten women who had encountered sexual violence by a male they knew well were interviewed about the effects of that experience on their everyday lives. The women described "knowing what to do" to manage their lives by using practical, everyday activities to cope with the violence. Their narratives were interpreted according to the Heideggerian concept of understanding as know-how. For Heidegger, understanding is not a cognitive process; rather, it is an implicit "knowing how" to do what is appropriate in each situation. Professionals who work with women who have experienced intimate sexual violence should seek to understand the women's intuitive understanding of what is possible and to appreciate the common sense ways they cope with life in a violent world.     

Perceptions of social stigma and its effect on interpersonal relationships of young males who experience a psychotic disorder

Background:  People with psychotic disorders experience high levels of disability and impairment as a result of their illness. Difficulty in the area of social relationships poses a substantial problem with the majority of people with psychosis being socially isolated. Many of them experience an unmet need for services.
Methods:  A focus group was conducted with the aim of investigating the perceived experience of six young men who had a psychotic disorder to gain an understanding of the impact this had on interpersonal relationships.
Results:  The major themes identified were: (i) a significant decrease in the internal and external control of one's life at the onset of illness; (ii) the effects of labelling and stigma on interpersonal relationships; and (iii) the change in self perception that these effects bring.
Conclusion:  The implications of the findings for rehabilitation interventions are presented, specifically psychosocial group interventions addressing interpersonal relationships.     

Injured workers' perspectives of their rehabilitation process under the New South Wales Workers Compensation System

Aim:  Occupational injury and the process of rehabilitation can impact significantly on an individual's life. Research on the perspectives of injured workers, and their perceptions of the occupational therapy role, is limited.
Method:  A qualitative, phenomenological study explored the experiences of six injured workers, from a large regional area health service, who had undergone occupational rehabilitation within the NSW Workers Compensation System. Data were collected through the use of in-depth, semistructured interviews and were analysed inductively.
Results:  Injured workers have a limited knowledge and understanding of the rehabilitation process, feel unsupported throughout the process, have unsatisfying return-to-work duties and often experience negative attitudes from key stakeholders.
Conclusion:  The results highlight the opportunity for occupational therapists to increase their role within occupational rehabilitation; however, they need to adopt a more holistic approach to their practice.     

Effects of early breastfeeding on neonatal glucose levels of term infants born to women with gestational diabetes

Background:  Infants born to diabetic women are at higher risk for hypoglycaemia related to hyperinsulinism in response to maternal hyperglycaemia during pregnancy. As such, recommendations to prevent neonatal hypoglycaemia include infant feeding in the early postpartum period. The present study aimed to examine the effect of early breastfeeding and type of nutrition used for the first feed (human milk or formula) on glucose levels in infants born to women with gestational diabetes.
Methods:  The prospective pilot study of 84 infants born to gestational diabetic women examined the glycaemic levels of infants who were breastfed in the delivery room compared to glycaemic levels of those who were not. The study also compared the glycaemic levels of infants who breastfed with those who received formula for their first feed.
Results:  Infants who were breastfed in the delivery room had a significantly lower rate of borderline hypoglycaemia than those who were not breastfed in the early postpartum period (10% versus 28%; Fisher's exact test., P  = 0.05,). Likewise, infants breastfed in the delivery room had significantly higher mean blood glucose level compared to infants who were not breastfed in the delivery room (3.17 versus 2.86 mmol L⁻¹, P  = 0.03). Additionally, breastfed infants had a significantly higher mean blood glucose level compared to those who were formula fed for their first feed (3.20 versus 2.68 mmol L⁻¹, P  = 0.002).
Conclusions:  Early breastfeeding may facilitate glycaemic stability in infants born to women with gestational diabetes.     

A randomized community intervention trial to increase awareness and knowledge of the role of periconceptional folate in women of child-bearing age

Objectives  To determine the effect of a consumer-directed information campaign to increase knowledge of folate for the prevention of neural tube defects among women of child-bearing age, and to measure women's recall of sources of information and knowledge about folate.
Design  A community randomized trial.
Setting  Three matched pairs of geographically distinct Local Government Areas in the state of Victoria, Australia.
Intervention  Printed information recommending folate intake to decrease the risk of neural tube defects was disseminated to women of child-bearing age in three of the Local Government Areas selected randomly.
Main outcome measure  The proportion of women aware of the association between folate and spina bifida.
Results  Of 1197 women interviewed prior to the intervention, 12.4% (adjusted for the cluster and population sampling unit) were aware of folate and neural tube defects. After the intervention, there was not only a significant background increase of 3.4% ( P =0.02) in folate awareness since the pre-intervention survey ( n =603), but also a significant additional increase of 4.0% ( P =0.04) owing to the intervention itself ( n =603). Only 70% of women who were aware of folate knew the correct timing.
Conclusions  The provision of printed educational material can increase folate awareness among women of child-bearing age. A comprehensive, long-term and ongoing health promotion campaign including such material, together with initiatives by relevant health service providers and the food industry, could best address the current low levels of folate awareness among women of child-bearing age.     

Modifiable and nonmodifiable factors associated with osteoporosis in postmenopausal women: results from the Third National Health and Nutrition Examination Survey, 1988-1994

We wished to study the relationship between modifiable and nonmodifiable factors that were correlated with osteoporosis using a national sample of women aged 50 years and older who have never been on hormone replacement therapy (HRT). We used a cross-sectional study design with a nationally representative sample with a detailed clinical examination and a home interview. Between 1988 and 1994, 1953 postmenopausal women who had never been on HRT, aged 50 years and older, were examined as part of the Third National Health and Nutrition Examination Survey (NHANES III). Mexican Americans and non-Hispanic blacks were oversampled to produce reliable estimates for these groups. Bone density measurements of four proximal femur sites were assessed by using x-ray absorptiometry (DEXA). A DEXA measurement at any single femur site indicated osteoporosis if it was >2.5 standard deviations (SD) below the reference mean of 20--29-year-old women. The study demonstrated that numerous factors, both modifiable and nonmodifiable, were significantly related to the prevalence of osteoporosis. The modifiable factors identified were participation in physical activity (three to five times per week) and body mass index (BMI). Nonmodifiable factors included age, race, and mother's history. With the aging population, osteoporosis is a growing concern for the medical community. It is suggested that educational strategies are needed to increase awareness of factors that contribute to maintaining bone health among postmenopausal women. Emphasis may be placed on maintaining regular physical activity.     

An ongoing six-year innovative osteoporosis disease management program: challenges and success in an IPA physician group environment.

The goal of this ongoing comprehensive osteoporosis disease management initiative is to provide the adult primary care physicians' (PCPs) offices with a program enabling them to systematically identify and manage their population for osteoporosis. For over six years, Hill Physicians Medical Group (Hill Physicians) has implemented multiple strategies to develop a best practice for identifying and treating members who were candidates for osteoporosis therapy. Numerous tools were used to support this disease management effort, including: evidence-based clinical practice guidelines, patient education sessions, the Simple Calculated Osteoporosis Risk Estimation (SCORE) questionnaire tool, member specific reports for PCPs, targeted member mailings, office-based Peripheral Instantaneous X-ray Imaging (PIXI) test and counseling, dual x-ray absorptiometry (DEXA) scan guidelines, and web-based Electronic Simple Calculated Osteoporosis Risk Estimation (eSCORE) questionnaire tools. Hill Physicians tabulated results for patients who completed 2649 SCORE tests, screened 978 patients with PIXI tests, and identified 338 osteopenic and 124 osteoporotic patients. The preliminary results of this unique six-year ongoing educational initiative are slow but promising. New physician offices express interest in participating and those offices that have participated in the program continue to screen for osteoporosis. Hill Physicians' message is consistent and is communicated to the physicians repeatedly in different ways in accordance with the principles of educational outreach. Physicians who have conducted the program have positive feedback from their patients and office staff and have begun to communicate their experience to their peers.     

Four years after graduation: Occupational therapists' work destinations and perceptions of preparedness for practice

Objective:  The present study sought to identify the work destinations of graduates and ascertain their perceived preparedness for practice from a regional occupational therapy program, which had been specifically developed to support the health requirements of northern Australians by having an emphasis on rural practice.
Design:  Self-report questionnaires and semistructured in-depth telephone interviews.
Participants:  Graduates ( n =  15) from the first cohort of occupational therapists from James Cook University, Queensland.
Main outcome measure:  The study enabled comparisons to be made between rural and urban based occupational therapists, while the semistructured interviews provided a deeper understanding of participants' experiences regarding their preparation for practice.
Results:  Demographic differences were noted between occupational therapists working in rural and urban settings. Rural therapists were predominantly younger and had worked in slightly more positions than their urban counterparts. The study also offered some insights into the value that therapists placed on the subjects taught during their undergraduate occupational therapy training, and had highlighted the differences in perceptions between therapists with rural experience and those with urban experience regarding the subjects that best prepared them for practice. Generally, rural therapists reported that all subjects included in the curriculum had equipped them well for practice.
Conclusions:  Findings suggest the need to undertake further research to determine the actual nature of rural practice, the personal characteristics of rural graduates and the experiences of students while on rural clinical placements.     

Perceived risks and reported behaviors associated with osteoporosis and its treatment

This study investigates older American women's knowledge and risk perceptions about osteoporosis and its treatment. Our results indicate that older U.S. women undervalue the health impact of osteoporosis; they consider it controllable, and neither life threatening nor dreaded relative to other possible diseases or conditions. At least 1/3 of older women in a diagnosed and general sample also confused osteoporosis with arthritis. Women scored highest on osteoporosis knowledge questions related to items under their personal control, such as diet or exercise. Further, women who understood the effects of a particular behavior on osteoporosis were more likely to act in accordance with that knowledge than were women who did not understand those effects.     

Bone density in a population of long term oral contraceptive pill users does not differ from that in menstruating women

Prevention of osteoporosis is a major public health issue. Amenorrhoeic women have lower bone density than normally menstruating women, which is related to the duration of amenorrhoea and the severity of oestrogen deficiency. Bone mineral density (BMD) in amenorrhoeic women can be improved by oestrogen replacement in the form of the combined oral contraceptive pill (COCP), so increased BMD might be an important non-contraceptive benefit of the COCP in menstruating women. Previous studies have been variably reported, but have used different methodologies for measurement of BMD. We measured BMD using the DEXA technique in long term COCP users and compared this with menstruating women who had never used the COCP. No differences in bone density were found, suggesting that the COCP does not improve bone mass in menstruating women who are adequately oestrogenised by their own ovaries.     

Contraceptive Use and Abortion Among Women Of Reproductive Age in St. Petersburg, Russia

CONTEXT: Although the characteristics associated with contraceptive use among Russian women have been studied, no large-scale research has been conducted on women's use of different contraceptive methods and abortion.
METHODS: A random sample of 1,147 women aged 18–44 completed questionnaires at local women's clinics in St. Petersburg in 2003–2004. Chi-square tests were used to examine differences in selected characteristics among age-groups, and logistic regression was used to assess associations between these characteristics and the use of contraceptive methods at last intercourse and abortion history.
RESULTS: Among women at risk of unintended pregnancy, six in 10 had used reliable contraceptives (the pill, the IUD or condoms) at last intercourse; 42% had used condoms. Women in the middle income level were more likely than women with lower income to have used the pill (odds ratio, 2.1); cohabiting women and those who had had children had lowered odds of using condoms (0.6 and 0.3–0.5, respectively). More than half of those surveyed reported having had an abortion. Characteristics associated with increased odds of having had an abortion included being 25 or older (2.2–3.5), cohabiting (2.9), having high income (1.7), having experienced first intercourse before turning 18 (2.2) and having used no contraceptive method at first sex (1.5). The factor that was most strongly associated with abortion was a woman's number of births (4.9–5.7).
CONCLUSIONS: Educational programs that promote the consistent use of condoms, especially among young women, and family planning programs that reduce financial barriers to contraceptive use, are critically needed in Russia.     

Interests that occupy 86-year-old persons living at home: Associations with functional ability, self-rated health and sociodemographic characteristics

Background and Aims:  Interest is generated from the experience of pleasure in occupational behaviour. However, there is little known about the type and amount of interests that occupy very old people. The aims of the present study were to explore the interests of people aged 86 years who are living at home (n = 205) and to study the association between these interests and functional ability, self-rated health and sociodemographic characteristics.
Methods:  Participants were interviewed during home visits and data were analysed by using content analysis and statistics.
Results:  Participants had a broad range of interests. Personal and environmental factors played a part in people giving up their interests. Participants who regarded their health as good or who had no problems in carrying out daily activities had more interests than those with poor health or limited ability to participate in daily activities. Few differences based on gender and sociodemographics were found.
Conclusions:  Being active (i.e. practising many interests) also means experiencing good health. In the name of occupational justice, it is important to enable elderly persons to pursue interests.     

Having a baby in Victoria 1989-2000: women's views of public and private models of care

Objective : To assess and contrast women's views of antenatal, intrapartum and postnatal care based on data collected in three state-wide surveys of recent mothers conducted in 1989, 1994 and 2000.
Methods : Postal surveys were mailed to all women who gave birth in Victoria in one week in 1989, and in two weeks in 1993 and 1999, excluding those who had a stillbirth or neonatal death. Questionnaires were sent to women by hospitals and home birth practitioners 5–8 months after the birth.
Results : 58.6% of women participating in the 1989 survey rated their antenatal care as 'very good' compared with 62.4% in 1994 and 66.5% in 2000 (χ² for trend=15.01, p <0.001). In all three surveys, women enrolled in public models of care were significantly more likely to rate their antenatal care as less than 'very good' than women enrolled in private models of care. More than two-thirds of the women in each survey rated their intrapartum care as 'very good' (1989–67%, 1994–71 %, 2000–72%). Over the time period there was an improvement in the proportion of women rating their care as 'very good' among women in private care (χ² for trend=33.1, p <0.001), but no improvement was seen in public care. Only 52% (1994) and 51% (2000) of women rated their postnatal care as 'very good'.
Conclusions : The conduct of three population-based surveys of recent mothers in Victoria over the past 10 years has provided valuable information for charting the impact of organisational changes on women's views and experiences of maternity care.