Women's Health Issues

To assess the ways in which social work is addressing issues in women's health care, the profession's journals from 1985-1992 were searched, yielding 36 articles. Over half addressed issues of rcproduction and sexuality including prcgnancy, Family nlanninc, abortion, substance abuse in pregnancy, and fetal oroteciion poficies. ~emainin~ articles addr&sea me&cal diagnoies; including AIDS/HIV/STDs, cancer, illnesses associated with aging, PMS, Turner's Syndrome, and chronic fatigue syndrome. Foci, methodologies, and recommendations are discussed and the authors critically analyze the articles' reflections of the status of women's health as a social work concern.     

Pap Smear Screening Among Women ≥40 years Residing at the United States–Mexico Border

Invasive cervical cancer is a preventable disease due to screening for precursor lesions using the Papanicolaou cytological testing (Pap smear). Participants were assessed regarding their access to and utilization of health care services, prevention orientation, history of chronic disease screening, and reproductive health history. Factors independently positively associated with Pap smear screening were age, clinical breast exam (CBE) in the last year, doctor recommendation of a Pap test, living in the United States, and checkup in the past year. Having a regular source of health care, as well as a doctor's recommendation for a Pap smear, appears to have a positive effect on women's Pap smear screening rates in U.S.–Mexico border communities.     

An analysis of Liberia's 2007 national health policy: lessons for health systems strengthening and chronic disease care in poor, post-conflict countries

Background

Globally, chronic diseases are responsible for an enormous burden of deaths, disability, and economic loss, yet little is known about the optimal health sector response to chronic diseases in poor, post-conflict countries. Liberia's experience in strengthening health systems and health financing overall, and addressing HIV/AIDS and mental health in particular, provides a relevant case study for international stakeholders and policymakers in other poor, post-conflict countries seeking to understand and prioritize the global response to chronic diseases.

Methods

We conducted a historical review of Liberia's post-conflict policies and their impact on general economic and health indicators, as well as on health systems strengthening and chronic disease care and treatment. Key sources included primary documents from Liberia's Ministry of Health and Social Welfare, published and gray literature, and personal communications from key stakeholders engaged in Liberia's Health Sector Reform. In this case study, we examine the early reconstruction of Liberia's health care system from the end of conflict in 2003 to the present time, highlight challenges and lessons learned from this initial experience, and describe future directions for health systems strengthening and chronic disease care and treatment in Liberia.

Results

Six key lessons emerge from this analysis: (i) the 2007 National Health Policy's 'one size fits all' approach met aggregate planning targets but resulted in significant gaps and inefficiencies throughout the system; (ii) the innovative Health Sector Pool Fund proved to be an effective financing mechanism to recruit and align health actors with the 2007 National Health Policy; (iii) a substantial rural health delivery gap remains, but it could be bridged with a robust cadre of community health workers integrated into the primary health care system; (iv) effective strategies for HIV/AIDS care in other settings should be validated in Liberia and adapted for use in other chronic diseases; (v) mental health disorders are extremely prevalent in Liberia and should remain a top chronic disease priority; and (vi) better information systems and data management are needed at all levels of the health system.

Conclusions

The way forward for chronic diseases in Liberia will require an increased emphasis on quality over quantity, better data management to inform rational health sector planning, corrective mechanisms to more efficiently align health infrastructure and personnel with existing needs, and innovative methods to improve long-term retention in care and bridge the rural health delivery gap.     

我国人群的主要卫生问题——全国疾病监测死亡资料分析

利用全国疾病监测系统的5年死因监测资料,使用标化死亡率、潜在减寿年数(YPLL)和失能调整的损失健康生命年(DALY),对我国人群的主要卫生问题进行了分析。由于人口的老龄化,感染性疾病死亡下降而导致慢性病相对重要性的上升,以及某些危险因素上升,致使肺癌等疾病呈上升趋势,从而我国的疾病模式不同于50年代的模式,呈现出这样的特点:虽然感染性疾病有所下降,构成比降低,但并未得到根本控制。同时,慢性病、意外伤害所导致的卫生问题上升,形成双重挑战。     

Better Late Than Never: Reflections on the Delayed Prioritization of Cervical Cancer in International Health

Cervical cancer has disproportionately affected the world's most vulnerable women for generations, yet only recently has the disease become an international health priority. Using ethnographic evidence from a study in Iquitos, Peru, I identify three factors that have contributed to a historic blind spot regarding cervical cancer in underdeveloped regions: (a) transition theories predicting the emergence of cancer with increasing societal development, (b) chronic vs. infectious disease categories that miss the significance of infectious-associated cancers, and (c) dependence on epidemiologic statistics from underdeveloped regions for determining health care priorities. Implications for theory and education are discussed.     

The Childbearing Concerns and Related Information Needs and Preferences of Women of Reproductive Age with a Chronic,Noncommunicable Health Condition: A Systematic Review

BackgroundCertain chronic health conditions and their treatments may compromise women's fertility; some chronic conditions are more likely to affect women of reproductive age than others, and some are heritable. All have implications for women's future childbearing and fertility management.ObjectiveThe aim of this systematic review was to identify the concerns about childbearing and related information needs and preferences of women with a chronic, noncommunicable health condition.MethodThe review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedure. Relevant social science and medical science databases (Ovid MEDLINE, ProQuest, and CINAHL plus) were searched for peer-reviewed, English-language papers published from 1995 to August 2012 of empirical research using quantitative or qualitative methods.ResultsOf the 5,350 articles identified, 29 met inclusion criteria and were reviewed. Despite variation in methods, the studies demonstrated consistently that women with a chronic health condition are concerned about childbearing and have questions about the reproductive implications of their condition. The evidence suggests that there is less consistency about women's preferences for the mode and timing of information about the effect of the condition and its treatment on childbearing. Most research to date has focused on the needs and experiences of women with cancer; there is almost none about other noncommunicable conditions.ConclusionThere are serious evidence gaps about the childbearing concerns and related information needs and preferences of women with chronic, noncommunicable health conditions. Research is required to address these gaps and to inform the development of appropriate tools to assist women in this situation with their childbearing decisions.     

Self-Efficacy and Rural Women's Performance of Breast and Cervical Cancer Detection Practices

Self-efficacy has become an important variable in multiple areas of human performance, including health behavior modification (Bandura, 1997). This study explores variables that lead to women's perceived self-efficacy in performing regular detection practices for breast and cervical cancer. A sample of southeastern U.S. farm women ( N = 206) completed surveys that assessed their perceived and actual knowledge of women's cancer detection practices, as well as their perceived social norms and perceived barriers related to obtaining these tests. Regression analyses of these data revealed that perceived peer norms and the barriers of time and embarrassment were significant predictors of women's confidence in their ability to follow through with cancer detection practices. Perceived knowledge and perceived family norms significantly predicted women's perceptions of difficulty associated with cancer detection practices as well as women's confidence in their skills to perform breast self-examination (BSE). Time was also a significant barrier to confidence in performing BSE. Implications for health communication campaigns are discussed.     

北京市医联体政策背景下慢病患者就医选择影响因素研究

目的:调查医联体建设背景下慢病患者就医选择的特征及状况,为了解患者的就医选择、进一步完善医联体建设提供依据,探讨促进医联体发展的政策建议。方法:对北京市某医联体慢病患者进行抽样调查,样本量为781名患者,使用SPSS21.0对数据进行统计分析。结果:慢病患者的就医选择与人口特征、对医联体的感知、患者满意度三个维度存在显著相关。具体来说,患者性别、年龄、受教育程度等倾向特征,收入、医保情况等使能资源,自感病情,评估健康状况,对医联体的认知和体验等方面均显著地影响患者就医选择。结论:医联体建设能够有效影响患者的就医选择,对引导患者合理就医、推进分级诊疗建设起到了切实有效的作用。但是,医联体建设在加强社区医疗卫生机构药物供给、双向转诊和宣传力度等方面仍需加强。     

A Guy Thing

Abstract

The Men's Movement, celebrity disclosures about prostate cancer, and recent epidemiologic research identifying gender-related health risks for men have all resulted in, and simultaneously fostered, a burgeoning demand for information on men's health issues. The Internet may serve as a convenient, timely, and interactive service complementing traditional print resources for patients, their families, and their affectional partners looking for information on sexual and reproductive health and other health conditions as they present in men. Included in this article is a select list of Web-based men's health resources, with annotations, available from the Internet.     

Are cancer registries unconstitutional?

Population-based cancer registration, mandated throughout the United States, is central to quantifying the breadth and impact of cancer. It facilitates research to learn what causes cancer to develop and, in many cases, lead to death. However, as concerns about privacy increase, cancer registration has come under question. Recently, its constitutionality was challenged on the basis of 1) the vagueness of statutory aims to pursue public health versus the individual privacy interests of cancer patients, and 2) the alleged indignity of one's individual medical information being transmitted to government authorities. Examining cancer registry statutes in states covered by the US National Cancer Institute's SEER Program and the US Centers for Disease Control and Prevention's National Program of Cancer Registries, we found that cancer registration laws do state specific public health benefits, and offer reasonable limits and safeguards on the government's possession of private medical information. Thus, we argue that cancer registration would survive constitutional review, is compatible with the civil liberties protected by privacy rights in the U.S., satisfies the conditions that justify public health expenditures, and serves human rights to enjoy the highest attainable standards of health, the advances of science, and the benefits of government efforts to prevent and control disease.     

The Working Patient with Cancer: Implications for Payers and Employers

Cancer is seen today more often as a manageable chronic disease, resulting in changing workplace characteristics of the patient with cancer. A growing number of employees continue to work while being treated for cancer or return to work shortly after their cancer treatment is completed. To respond to these changes and the potential impact on the working patient''s attitude, employers need updated, factual information related to this patient population. This type of information will support future benefit considerations by employers on employee contributions and future employee health and productivity. In 2005, Amgen launched a 3-year initiative to better understand cancer as a chronic disease, as well as the impact on the working patient with cancer and on the employer. The data from this initiative described in this article provide insights into cancer as a chronic and manageable disease in the workforce, and the broader implications to payers and employers.Advances in the diagnosis and treatment of cancer in recent decades have dramatically improved the life expectancy, quality of life, and productivity of patients with cancer. Today, a growing number of employees remain in the workforce while they are being treated for cancer or return to work after their treatments are completed. Cancer is being seen as a chronic and manageable disease in the workforce, similar to diabetes or asthma. Henry and colleagues report that the most cited reasons why employees with cancer remain on the job either full-time or part-time are because they need to work, prefer to work, or feel well enough to work.1 In addition, working patients with cancer are taking on an increased burden for costs related to their cancer treatments through cost-shifting.2 In response to this cost-shifting environment and subsequent impact on employee cost burden and changing work patterns and productivity, it is imperative that employers and payers, like managed care organizations, work toward developing a better balance of benefit designs and employee contributions/copayments with employee health and productivity.     

我国慢性病管理现状、问题及发展建议

慢性非传染性疾病对我国居民健康造成较大威胁,慢性病管理工作是我国卫生工作的重点。本文通过文献和相关政策研究,从宏观—政策,中观—组织机构间的协调,微观—患者和人群三个层面对我国慢性病管理工作进程进行梳理归纳,并立足我国慢性病管理实际提出我国慢性病管理仍存在的一些问题。建议未来的慢性病管理工作应注重提炼慢性病管理理论模型;结合医改分级诊疗工作的推行,构建整合式慢性病管理服务网络;加快提升慢性病管理"终端"能力建设。     

The context of coping: a qualitative exploration of underlying inequalities that influence health services support for people living with long‐term conditions

Coping with chronic illness encapsulates both practical and emotional aspects of living life in relation to one's long‐term health condition(s). Dominant health psychology approaches for understanding coping, which underpin a more recent policy discourse on ‘self‐management’, focus sharply on the person affected by illness and potentially mask the influence of overarching social structure. In this paper we draw on qualitative interviews with 48 people living with long‐term conditions (LTCs), in order to highlight the role that structural configurations such as healthcare systems may play in either helping or hindering people's efforts to cope with chronic illness. We argue that coping is a social process in which health and related services, situated within their wider political‐economic contexts, play an active role in shaping people's attempts to live well with LTCs. More specifically, health systems are sites of social and cultural capital exchange that can differentially mobilise coping resources through access, continuity of care, and coordination across services. Whilst it is essential to recognise the personal agency of people living with chronic illness, it is also vital to acknowledge the underlying inequalities that affect the ways in which services can support such resourcefulness.     

社区居家养老意愿下居住方式和子女支持对老年人基层卫生服务需求的影响

目的:探讨居住方式和子女支持对老年人基层卫生服务需求的影响,使基层卫生服务更具针对性,以满足不同居家类型老年人的卫生服务需求.方法:利用2016年中国老年社会追踪调查数据,采用负二项Hurdle回归模型(NBH模型)分析.结果:与子女同住会显著提高城乡居家老年人对基层卫生服务的需求(P<0.05),子女经济支持则会显著...     

以需求为导向的我国老年人医养结合影响因素研究

目的:分析我国老年人的健康需求、影响因素及存在的问题,为优化医养结合、促进健康老龄化提供依据。方法:利用2013年中国健康与养老追踪调查(CHARLS)数据,采用描述性统计、有序多分类logistic、二分类Logistic回归以及多重线性回归分析。结果:西部地区、农村地区以及患慢性病的老年人自我健康评价较差(P0.001),城镇老年人生活方式和健康行为优于农村老年人(P0.01),子女和配偶支持水平、老年人生活方式和健康行为呈正相关(P0.01);西部地区、患慢性病以及未参保老年人卫生服务利用低于中东部、未患慢性病以及参保老年人(P0.01);农村地区、与子女一起居住的老年人卫生支出占比较城镇地区和未与子女一起居住的老年人高(P0.01),患慢性病、和配偶生活在一起的老年人卫生支出占比较未患慢性病以及分居、离异、丧偶或未婚的老年人高(P0.01)。结论:我国老年人医养结合需求率较低,疾病经济负担仍然较大,支付意愿不够强烈,应推进社区居家养老,更加注重老年人的尊严问题,探索农村地区医养结合新模式,完善老年人长期护理保险制度。     

浙江省慢性病综合监测系统构建及应用研究

构建符合WHO推荐的非传染性疾病综合监测系统,研制关键技术并推广应用,获得主要健康指标以及慢性病流行状况和变化趋势,为慢性病防控和科学研究提供支撑。通过因子分析、K-means聚类分层以及多组合整群随机抽样,设计并建立了具有省级代表性的30个样本监测地区;在参考WHO非传染性疾病监测框架以及美国行为危险因素抽样和调查问卷基础上,结合我国实际需求,构建了涵盖发病和死亡等结局、危险因素暴露和社区慢性病管控3方面内容的慢性病综合监测系统;形成了监测数据收集、管理、分析和反馈的“5+12+1”全过程质量控制体系;研发了集生命登记、慢性病病例报告与社区主要慢性病管理等功能于一体的省-市-县三级监测信息管理平台和信息技术建设标准。应用上述关键技术,获得了全省高质量的监测数据,产出主要健康指标,开展慢性病科学研究,阐述主要慢性病及其危险因素的流行现状和变化趋势,助推政府民生改革实事项目,助力“健康浙江”建设。监测成功经验和关键技术已推广应用于全国及部分省市慢性病监测系统建设。     

Women's Health Care Centers

Feminist health and holistic health movements predate and contribute to the currenl changes in women's hcalth care. Recentlv, there has been r rivilalization of women's IiealUi centers reflechg three approaches to women's health: (1) centers with an exclusive focus on one health problem, e.g., breast cancer, chemical dependency (2) centers with a predominantly reproductive focus, and (3) centers with a holistic/feminist health care focus. Based on an exploratory survey of women's centers in a large city, this paper identifies differences among them and discusses the potential for misguidance that may occur with the current increase in women's health centers. It also discusses the implications of this growth for social work education and clinical practice.     

Cancer literacy as a mediator for cancer screening behaviour in Korean adults

This study investigates the cancer literacy level in Korean adults and examines whether cancer literacy plays a mediating role in the relationship between population characteristics and cancer screening behaviours. We collected data from 585 community‐dwelling adults in Korea using self‐administered surveys and face‐to‐face interviews from October to December in 2009. Guided by Andersen's behavioural model, we used a structural equation model to estimate the effect of cancer literacy as a mediator and found that cancer literacy mediated cancer screening behaviour. In the individual path analysis models, cancer literacy played a significant mediating role for the use of eastern medicine, fatalism, health status and the number of chronic diseases. When controlling for other relevant covariates, we found that in the optimal path model, cancer literacy played a mediating role in the relationship between the use of eastern medicine and self‐rated health status as well as cancer screening behaviour. Thus, developing community‐based cancer education programmes and training clinical practitioners in eastern medicine clinics about the importance of informing their patients about regular cancer screening may be an option to boost cancer literacy and screening behaviour in Korea.     

The Experience of Living With Metastatic Breast Cancer—A Review of the Literature

Women's experiences with metastatic breast cancer have received little research attention. We reviewed published articles (1984–2013) reporting research examining women's experiences of metastatic breast cancer (n = 33). Findings from quantitative studies were categorized into three broad areas: adverse consequences, satisfaction with health care providers, and strategies for living. Themes identified from qualitative findings include living as a social outsider; importance of hope; health and quality of life; positive experiences; experiences at end of life; and strategies for living. More research is needed to explore experiences of subgroups to appropriately respond to women's diverse care needs.