Correlates of Community Health Service Utilization for Menopausal Symptoms among Urban Japanese Women

ABSTRACT Objectives: This study aims to identify the factors associated with community health service utilization for menopausal symptoms among Japanese women in urban areas by using Andersen's behavioral model of health service use.
Design: A cross-sectional study was conducted.
Sample: The sample comprised 350 women aged 40–60 years living in a community in Japan.
Measurements: The independent variables were predisposing (demographics, social status, and health beliefs), enabling (family and community resources), and need factors (perceived health status and the need for community health services). The dependent variable was community health service utilization. A logistic regression model was used.
Results: 8 of the women were categorized in "treatment required" by simplified menopausal index score, and 103 women said that they would use the services. Knowledge regarding the services, OR: 1.814 (1.084–3.036); the absence of a negative attitude toward menopausal syndromes, OR: 0.605 (0.367–0.998); and the presence of a positive attitude, OR: 2.203 (1.070–4.536); influenced community health service utilization.
Conclusions: An appropriate attitude toward menopausal symptoms was observed to be more relevant to community health service utilization than the experience or acuity of the menopausal symptoms themselves. Therefore, community-dwelling, middle-aged women should be provided with sufficient education regarding menopausal symptoms to encourage their utilization of community health services.     

Homeless women and children's access to health care: a paradox

Homeless women and children who reside in shelters experience many health-related problems. The aim of the qualitative study reported here was to (a) explore how shelter staffs manage health problems among their residents and assist them in accessing health services, and (b) identify clinical strategies for community health nurses working with this population. Findings demonstrate a paradox whereby homeless shelter staffs try to gain access to care for their residents through a system that is designed to keep them out. In addition, findings indicate a need for increased community health nursing services in homeless shelters. Strategies for resolving this paradox include providing assessment, policy development, and assurance of health care for homeless women and children.     

Effects of Coresidence and Caregiving on Health of Thai Parents of Adult Children with AIDS

Purpose: To explore potential effects on the health of older parents living with and caring for people infected with HIV.
Design: Comparison of health outcomes between affected parents and matched nonaffected parents, and between principal caregivers and nonprincipal caregivers in Thailand.
Methods: Survey data from 394 affected households and 376 nonaffected households; qualitative data from 18 interviews of affected older parents.
Results: A large proportion of older people with HIV-infected children provided time-consuming and strenuous caregiving services to them. Mothers shouldered most of this burden. Mothers who had a child die from AIDS reported lower levels of overall happiness than did others who had not. Mothers and fathers of PHAs (persons with HIV/AIDS) who died reported lower levels of overall happiness compared to 3 years previously (before the time of the death of their child) and compared to parents from households that did not experience an adult child's death. Many parents of children with AIDS experienced anxiety, insomnia, fatigue, muscle strain, and head and stomach aches during the time they cared for their ill children.
Conclusions: Many older people suffered adverse health outcomes related to living with and caring for their children with AIDS. Recommendations indicate a variety of programs that might help such older parents.     

. . . on Foster Care International Society of Psychiatric-Mental Health Nurses

PROBLEM:  Mental health problems are particularly widespread for foster children. There are approximately 700,000 youth in foster care and nonfamily settings in the United States. The mean entry age is 3 years. The average stay is 2 years. Experts estimate that between 30% and 85% of youngsters in out-of-home care have significant emotional disturbances. Foster care children represent 5% of Medicaid enrollees but use approximately 40% of Medicaid funds. A substantial number of these children have psychological problems so serious that they require residential placement. Adolescents living with foster parents or in group homes have about four times the rate of serious psychiatric disorders than those living with their own families (2009a). Despite this level of need, less than one-third of children in the child protective system are receiving mental health services (2009a).
SOURCES:  Child psychiatric nurse advocates from the Association of Child and Adolescent Psychiatric Nurses Division of the International Society of Psychiatric-Mental Health Nurses compiled this position statement for adoption by the Board of Directors as the Association's formal statement on the plight of children and adolescents in foster care.
CONCLUSIONS:  Areas that need to be addressed include (a) lack of consistent and comprehensive service planning; (b) communications across agencies and with the youth, their foster parents, and key stakeholders; (c) use of evidence-based interventions to prevent and reduce the incidence of disability; (d) education of child welfare case workers about mental and emotional therapeutic management; and (e) education of foster parents and youth about mental health issues and appropriate treatments.     

Food-related health perceptions and food habits among older women

AIM: The aim of the present study was to explore food-related health perceptions and food habits among older women. BACKGROUND: Food-related health promotion has its main focus on disease prevention. With a holistic perspective on health, social and psychological aspects also need to be considered for total wellbeing. METHODS: Qualitative interviews, representing an ethnographic approach, were carried out with 18 women, aged 65-88, living alone or cohabiting, who independently managed shopping and cooking. Interviews were conducted at the women's homes, and analysed for coherent themes. The women also gave data on three days' eating and drinking in a food diary. FINDINGS; Two themes were found: 'A healthy slimming meal or the usual' and 'Meals -- a pleasure or an obligation'. The first theme summarized the women's health perceptions related to food, where the dominating view was fear of fat. Some also had a bad conscience about not eating according to recommendations. Use of low-fat products was not a predominant habit among these women. In the second theme, meals in fellowship were perceived as a pleasure, while women living alone tended to simplify cooking and eating. This was also reflected in their food habits, with fewer cooked meals, as well as events with coffee with cakes, compared with cohabiting women. CONCLUSIONS: Food-related health promotion must pay more attention to women living alone. Women who have lost their partners, may be at risk for poor nutritional intake as they often simplified the entire meal situation, while cohabiting women perceived food and cooking as a central task in their lives. One responsibility for nurses working in the community is to recognize and assess older women's deficient eating habits, assess them and plan eating together with the woman to prevent poor nutritional intake. Relatives and community staff could also be involved in this work.     

Nursing Children and Adolescents With Bipolar Disorder: Assessment, Diagnosis, Treatment, and Management

TOPIC:  The role of the mental health nurse in the assessment, diagnosis, treatment, and management of children and adolescents with bipolar disorder in community and hospital settings.
PURPOSE:  In many areas of clinical practice, mental health nurses have more contact with service users than any other professional group. They are therefore well placed to support children and adolescents with bipolar disorder during first contact with primary care services, through engagement with specialist mental health services, and in accessing early intervention and crisis services. This paper summarizes the contribution that child and adolescent mental health nurses make to the care of children and adolescents with bipolar disorder.
SOURCES:  This paper is based on evidence from systematic reviews; meta-analyses and best practice evidence from CINAHL; EMBASE; MEDLINE, PsychINFO; Cochrane Collaboration; National Institute for Health and Clinical Excellence; National Collaborating Centre for Mental Health; NHS Centre for Reviews and Dissemination; Oxford Centre for Evidence Based Medicine; United States Agency for Healthcare Research and Quality.
CONCLUSIONS:  Child and adolescent mental health nurses work with children and adolescents who have bipolar disorder in a range of settings. These include community mental health services, hospitals, and schools. Due to the multidisciplinary nature of the treatment and management of bipolar disorder during childhood and adolescence, nurses have a major role to play in providing frontline assessment services, monitoring treatment, and delivering psychosocial interventions.     

RN-to-MSN students' attitudes toward women experiencing homelessness: A focus group study

When health professionals, including RNs, have negative attitudes toward women experiencing homelessness, they create barriers to services. It is incumbent on nursing faculty to develop curricula that address homelessness and associated stereotypes, as well as to prepare students to provide safe and appropriate care to the homeless population. The aim of this qualitative study was to examine the attitudes of RN-to-MSN students toward mothers living with their children in a transitional shelter. A convenience sample of 10 students enrolled in a community health nursing course at a university in southern California participated in the study. Two focus groups were conducted: one before and one after a 15-week clinical experience. Data analysis revealed that during the clinical experience, students discovered that they, or perhaps an individual like them, could become homeless. Their attitudes and views changed to include a bigger picture of homelessness, described by public health nursing researchers as "moving upstream." This article suggests strategies for integrating clinical experiences with socioeconomically vulnerable individuals into undergraduate nursing curricula.     

The mental health needs of refugee children: A review of literature and implications for nurse practitioners

Purpose: To review the current literature regarding the mental health needs of refugee children resettled in the United States and provide recommendations for clinicians working with refugee children and their families.
Data sources: An extensive review of journal articles published from research conducted in first-world countries such as the United States, the United Kingdom, Australia, the Netherlands, and Canada.
Conclusions: Review of the current literature suggests that while some refugee children will suffer poor mental health outcomes, such as post-traumatic stress disorder, depression, and anxiety, others may not. Several groups of researchers concluded that refugee children are actually a high functioning group. Many coping and protective factors as well as risk factors for poor outcomes have been identified by the research.
Implications for practice: Because many refugee children will experience adverse psychosocial outcomes during the resettlement period, it is essential that the mental health screenings be performed during each primary care visit. Nurse practitioners have the unique opportunity to make a difference in the lives of refugee children because they play a pivotal role in the assessment, screening, and referral of children for mental health services.     

Support for teenage mothers: a qualitative study into the views of women about the support they received as teenage mothers

AIM OF THE STUDY: To gain insight into the support teenage mothers received during pregnancy, birth and their child's pre-school years and young women's perceptions of the usefulness of a support group for teenage mothers. BACKGROUND: Most qualitative studies have focused on teenage mothers around the time of the birth of their first child. For this study, women were recruited several years after the birth (median 8.5 years), so that they would have had time to reflect on the support they had received. DESIGN: The qualitative method of semi-structured interviews was chosen to obtain in-depth information and to allow teenage mothers' own views to be heard. Ten individual interviews and one paired interview were undertaken. FINDINGS: Recruitment was difficult because taking part in research was not a priority for many of the women. The study confirmed the strong link between deprivation and teenage pregnancy found in other studies, and suggested that mental health problems in teenage mothers may be more difficult to detect. Teenage women need more information on mental health and on services available to them. The fear, expressed by some of the women in this study, of becoming different from other women in their social network should be considered by health workers when establishing intervention programmes. CONCLUSIONS: Professional bodies of health workers should lobby government to provide a minimum standard of living and sufficient child-care to combat deprivation. Former teenage mothers should be involved in the recruitment, planning and implementation stages of research and interventions. Health professionals should be aware that mental health problems in teenage mothers may be particularly difficult to detect. Key community health workers or a support group may provide information on services, mental health and education facilities available that would benefit teenage mothers. A support group may also give emotional support.     

Latino Disparities in Child Mental Health Services

TOPIC:  Access and utilization of mental health services for Latino children.
PURPOSE:  As Latino children may experience higher rates of unmet needs, this article examines the current literature for the reasons for the disparity and the barriers to the utilization of mental health services for Latino children.
SOURCES:  An integrative literature review was undertaken from child psychiatry and nursing.
CONCLUSIONS:  The literature confirmed a pattern of underutilization of mental health services by Latino children, but did not completely address the reasons for the disparity. Suggested barriers were language and cultural issues. Gaps in the literature include a lack of agreement for definition of a mental health problem and the tools to identify these, insufficient studies into the barriers for Latino children in the access and utilization of mental health services, and cultural and language issues related to Latino research.     

Living Arrangements,Social Networks,Health, Mobility,and Balance of Older Women

ABSTRACT

Background: The aim of this study is to add to the literature research-based documentation by comparing a variety of characteristics of older women of 75 years or more in Oslo who live alone with women who live with a partner regarding demographic factors, their social networks, health, and mobility. Methods: In a cross-sectional study, a random sample of 307 women aged 75 years and over (mean 80.8 years, response rate 74.5%) and living at home were interviewed and tested regarding demographic factors, their social networks, health, mobility, and balance. Results: The mean age of the women was 80.8 years, and 76.5% of them were living alone. Fewer years of education, less frequent outdoor walking, difficulty in keeping their balance while walking, more frequently feeling their hearts pounding and suffering from shortness of breath, feeling lonely, and having a low score on the Timed Up and Go (TUG) test are factors independently associated with living alone. The strongest independent relationship existed between feelings of loneliness and living alone. Conclusion: Women living alone reported more frequently feeling lonely, have less years of education, were frailer, and had worse mobility problems than women living with a partner.     

Self‐rated health – what does it capture at 1 year after childbirth? Investigation of a survey question employing thinkaloud interviews

Aim:  This paper reports an investigation of how the survey question 'How would you summarize your state of health at present' is interpreted and what it captures when asked at 1 year after childbirth.
Background:  Self-rated health measured by a single item question is a well-established patient outcome as it predicts morbidity and the use of health services. However, there is limited understanding of what the question captures in early motherhood.
Method:  A qualitative design combining data collection by means of a short form, concurrent and retrospective thinkaloud interviews, and a semi-structured interview, with 26 Swedish women during 2005 was employed. The text was analysed by qualitative content analysis. A theoretical framework describing four cognitive tasks usually performed when a respondent answers a survey question guided the analysis: interpretation of the question, retrieval of information, forming a judgement and giving a response.
Findings:  The questions of self-rated health left open for the new mothers to evaluate what was most important for her. It captured a woman's total life situation, such as family functioning and well-being, relationship with partner, combining motherhood and professional work, energy, physical symptoms and emotional problems affecting daily life, stressful life events, chronic disease with ongoing symptoms, body image, physical exercise and happiness. Neither childbirth-related events nor childbirth-related symptoms were included in the responses. Less than 'good' self-rated health represented a high burden of health problems.
Conclusion:  Our results showed that the question on self-rated health was a measure of women's general health and well-being in their present life situation, but it did not seem to measure recovery after childbirth specifically.     

Factors Associated With Parental Distress

PROBLEM:  Associations of perceptions of social support, personal control, and child behavioral problems to distress in parents of children with mental health problems were examined.
METHODS:  One hundred and fifty-five parents of children 2–19 years old receiving community mental health services participated.
FINDINGS:  Stepwise regression analysis identified internalizing and externalizing child behaviors, perceived personal control, and tangible social support as independent predictors of parental distress. Independent predictors of objective distress included internalizing child behaviors, perceived personal control, and intangible social support.
CONCLUSIONS:  Internalizing and externalizing child behaviors were significantly associated with parental distress. Perceived personal control moderated the relationship between internalizing child behaviors and parental subjective distress.     

“We are always asked; ‘where are you from?’”: Chilean women’s reflections in midlife about their health and influence of migration to Sweden

Scand J Caring Sci; 2010; 24; 445–453
“We are always asked; ‘where are you from?’”: Chilean women’s reflections in midlife about their health and influence of migration to Sweden Aim: This study explored how Chilean immigrant women living in Sweden perceived and related their life situations and health status during midlife to their migration experiences. Method: Three focus group discussions (FGDs) were performed with 21 middle‐aged Chilean women (40–60 years) who had lived in Stockholm for at least 15–20 years. In‐depth interviews were held with three key informants. A combination of manifest and latent content analysis was performed to structure and categorize the tape‐recorded and transcribed data. Findings: Three main themes emerged from the data: (i) Chilean women’s reflections about migration and resettlement; (ii) Health during midlife; perceptions of Chilean women living in Sweden; and (iii) Strategies to manage their lives and to gain social acceptance and position. The Chilean women reflected about the discrimination they had met in the Swedish society and within the health care system along with health changes they had had during midlife. They connected some of their health related problems to their hardships of migration. They also expressed confusion about the health care they had received in Sweden including conflicting and mistrusting relationship with some health care providers. Important for their way of coping with their own health seemed to be a recognition of their own space, level of independence, self‐acceptance and awareness of power relationships. Conclusion: The results illuminate the importance of awareness of influence of gender and socio‐cultural aspects, power relationships and communication skills among health care providers on women’s health. Complementary interventions to the biomedical paradigm are needed and should be addressed in Swedish health staff educational programmes as well as in clinical training.