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.     

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.     

How Much Public Health in Public Health Nursing Practice?

Public health nursing (PHN) practice is defined by an emphasis on population health issues rather than individually focused clinical interventions, but the actual scope and focus of PHN practice have not been well documented. The purpose of this survey was to investigate the practice activities, priorities, and education of public health nurses in California. Public health nurses in five counties were surveyed about interventions targeted at individual-family, community, and system levels. Summary scales (range: 1-4) were created to measure self-rated PHN activity, importance, and education at each level. Staff were most likely to perform individual-family level interventions (mean score, m=2.55), followed by community (m=1.86) and system-level interventions (m=1.46). Managers rated individual-family level interventions as most important (m=2.91) and community-level interventions (m=2.42) as more important than those at the system level (m=1.99). Individually focused case management was the most frequently performed and highly valued intervention. Staff and manager-directors deemed individual-family interventions as the area in which public health nurses were best educated, followed by community and then system interventions. Results indicate that the population health focus of public health nursing is not reflected in the practice activities, management priorities, or educational preparation of public health nurses.     

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.     

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’s Experiences of Miscarriage in the Emergency Department

IntroductionMiscarriage is a common event, usually managed in the emergency department. Although studies have examined the impact of miscarriage on women’s mental health and the effects of their dissatisfaction with health care received, little is known about the characteristics of the miscarriage experience in the emergency department. The objective of this study was to identify characteristics of care management that may have contributed to the difficulties experienced by women presenting with miscarriage in the emergency department.MethodsForty-eight women treated at 4 emergency departments in different regions of Quebec, Canada, were interviewed for 60 to 90 minutes. A thematic qualitative analysis of these interviews was performed.ResultsAnalyses revealed that participants’ experiences were characterized particularly by a lack of information at 3 critical junctures of the miscarriage experience: the announcement of the miscarriage, the course of the miscarriage, and the ED discharge. The topics on which the women lacked information were categorized into 7 subthemes within these junctures.DiscussionLack of information throughout the care management of miscarriage exacerbated the already-difficult nature of this event for the participants. Training emergency nurses to give adequate and complete information enables the delivery of compassionate care, potentially making a difficult situation less traumatic.     

Public Health and School Nurses’ Perceptions of Barriers to HPV Vaccination in Missouri

Human Papilloma Virus (HPV) is associated with various forms of cancer and is preventable with vaccination. Nurses are in a unique position to directly influence a person’s decision to receive the HPV vaccine. A statewide sample of both school and public health nurses was used to assess knowledge and attitudes related to the HPV vaccine as well as nurse’s behaviors and behavioral intentions toward educating parents and recommending the vaccine. Positive attitudes and adequate knowledge levels were found, however, the majority of school nurses did not provide information and resources to parents. Targeted health promotion programs for school nurses are recommended.     

Women’s Choice Regarding Breastfeeding and Its Effect on Well-Being

Because of the many known maternal and neonatal health benefits of breastfeeding, there have been significant efforts to encourage exclusive breastfeeding, and many hospitals follow the guidelines of the Baby-Friendly Hospital Initiative. However, even with the right support, many women are unable to exclusively breastfeed, which may make them feel anxious and/or depressed. Psychological pressure to exclusively breastfeed has the potential to contribute to postpartum depression symptoms in new mothers who are unable to achieve their breastfeeding intentions. In this commentary, we focus on the well-being of the mother–infant dyad and argue for further research on maternal stress related to breastfeeding difficulties or pressure and the need to physically and psychologically assess and support women who are unable to breastfeed successfully or exclusively.     

Measles—What’s Old Is New Again

Measles (rubeola) was once nearly eradicated in the United States. Unfortunately, it has reappeared, with more than three times the number of confirmed cases in 2019 than in 2018. The virus, which produces a distinct rash that appears within days of exposure, can spread quickly and can produce severe complications. There is no cure; treatment is supportive care. Measles was once a minimal concern in the United States due to high vaccination rates. The Centers for Disease Control and Prevention reports that, because of the increase in individuals traveling to countries with high rates of measles and the fact that fewer U.S. children are being immunized against measles, the incidence of measles will likely continue to rise in the United States. It is vital that nurses and other health care providers educate individuals about the importance of the prevention and treatment of measles.     

Women’s knowledge of and attitude towards disability in rural Nepal

Purpose: What is perceived to be a disability is both culturally specific and related to levels of development and modernity. This paper explores knowledge and attitudes towards people with disabilities among rural women in Nepal, one of the poorer countries in South Asia. Method: Four hundred and twelve married women of reproductive age (aged 15–49 years), from four villages in two different parts of Nepal, who had delivered a child within the last 24 months preceding the study, completed a standard questionnaire. Results: The majority of the participants only considered physical conditions that limit function of an individual and are visible to naked eyes, such as missing a leg or arm, to be disability. Attitudes towards people with disability were generally positive, for example most women believed that disabled people should have equal rights and should be allowed to sit on committees or get married. Most respondents thought that disability could result from: (i) accidents; (ii) medical conditions; or (iii) genetic inheritance. Fewer women thought that disability was caused by fate or bad spirits. Conclusions: There is need to educate the general population on disability, especially the invisible disabilities. There is also a need for further research on disability and its social impact.

Implications for Rehabilitation

• There is need to educate the general population on disability, especially the invisible disabilities and its rehabilitation. There is also a need for further research on disability and its social impact.

     

Effects of Turner Syndrome on Women’s Self-Esteem and Body Image

The present study examined if women with Turner Syndrome (n = 24) differed from women without Turner Syndrome (n = 63) in self-esteem and body image. Women with Turner Syndrome were recruited through the Turner Syndrome Society of Canada and from Turner Syndrome Facebook groups, while the comparison group was comprised of undergraduate university students. Questionnaire measures included the Rosenberg Self-Esteem Scale (Rosenberg 1965), the State Self-Esteem Scale (Heatherton and Polivy 1991), and the Body-Esteem Scale (Mendelson and White 1982). It was hypothesized that women with Turner Syndrome, who tend to be short in stature, would have lower self-esteem and poorer body image than women without Turner Syndrome. While women with Turner Syndrome scored significantly lower on body esteem and on general, social, and appearance-related self-esteem, it is notable that they did not differ from women without Turner Syndrome on performance-related self-esteem. Implications related to the promotion of positive body image and self-esteem in girls and young women with Turner Syndrome are discussed.     

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.     

Fournier’s gangrene: Is it scrotal gangrene?

INTRODUCTION: Fournier's gangrene was originally described as scrotal gangrene in young males. Today, it is generally accepted as synergistic necrotizing fasciitis of perineal, genital, or perianal regions, and the epidemiologic data have changed. However, there are still limited data about females due to the lack of female patients, even in large case series. METHODS: A retrospective review of the medical records of all patients who received surgery for emergency conditions over the past 22 years was performed to identify patients with Fournier's gangrene. Data from these patients were then reviewed to determine the age, gender, etiology, causative bacteria, predisposing factors, treatment modalities, length of hospital stay, and morbidity and mortality rates associated with Fournier's gangrene. Data were evaluated using multivariate analyses. RESULTS: Sixty-five patients (20 female) were identified with the diagnosis of Fournier's gangrene. The mean age was 50.8 years. The most common etiology was hemorrhoidectomy in male and perianal abscess in female patients. The most commonly isolated microorganism in both male and female patients was Escherichia coli. Twenty-nine patients had diabetes mellitus, which was the most common predisposing factor. Mean hospitalization time was 24.4 days and the overall mortality was 27.70%. CONCLUSION: Fournier's gangrene is still an important disease with high mortality rates in spite of the developments in intensive care units and new-generation antibiotics. It seems that there are no major differences between male and female patients in the characteristics of the condition.