Preference,knowledge and utilization of midwives,childbirth education classes and doulas among U.S. black and white women: implications for pregnancy and childbirth outcomes

ABSTRACT

This secondary analysis explored preference, knowledge and utilization of midwifery care, childbirth education and doula care among 627 black and white women at three Midwestern U.S. health clinics. Women who were white, more educated, not living in a high crime neighborhood, and privately insured were more likely to attend childbirth classes. Sociodemographic factors that predicted having heard about doula care included being more educated and having a partner. None of the sociodemographic variables predicted midwifery care. Education about existing childbearing resources and availability of low-cost options should be expanded, particularly for black women and those with low resources.     

Approaches to experiential learning, course delivery and validation in medicine. A background document

Educational models and approaches change over time in their dominance and use, offering a wide selection to educational planners and teachers. This paper discusses aspects of experiential learning, distance learning, learning contracts, portfolios, reflection, appraisal, assessment and validation of education. It offers triggers to further thought and enables the analysis of current educational practice.     

Health,education and time preference

Education has been shown to be the most important correlate of health. However, the mechanism through which education influences health has been largely unexplained. Grossman argued that education improves health production efficiency. In contrast, Fuchs argued that the association between health and education is not primarily causal but reflects unobserved causes of both outcomes. Instead of education causing better health, some ‘third’ variables may be related to both education and health. The ‘third’ variable most frequently mentioned is time preference. The aim of this paper is to investigate the role of time preference in the relationship between education and health. The role of risk attitude is also investigated. The paper exploits a unique data set of households that incorporated stated preference questions eliciting individuals' time preferences. The results show that the effect of education reduces but does not disappear when controlling for individuals' time preferences. Copyright © 2010 John Wiley & Sons, Ltd.     

Problem-solving in the fields: an action-oriented approach to farmworker education about pesticides.

This paper describes two educational programs initiated to address the problems of farmworker pesticide poisoning in Nicaragua and in the United States and Puerto Rico. Both programs utilize a participatory and action-oriented educational methodology known as popular education. The methodology is presented using examples to demonstrate its application to the planning, delivery and evaluation of pesticide education programs. Preliminary outcomes of using this methodology are also explored as well as implications for developing future training programs in the field.     

Opportunities to improve maternal health literacy through antenatal education: an exploratory study.

This paper examines the concept of maternal health literacy, defined as the cognitive and social skills that determine the motivation and ability of women to gain access to, understand, and use information in ways that promote and maintain their health and that of their children. Specifically, it investigates the feasibility of using the concept of health literacy to guide the content and process of antenatal classes. The paper reports on the results of focus groups and interviews conducted with a range of health care providers, pregnant women and new mothers to obtain different perspectives on the issues surrounding antenatal education and parenting. The results give us a realistic look at what women are learning from existing antenatal education and how it can be improved. Comparing the results from the educators and the women, the same basic issues surface. Both recognize that there are serious time limitations in antenatal classes. These limitations, combined with natural anxiety and curiosity about childbirth, generally ensure that the content of classes is confined to pregnancy and childbirth. The limitations of time are also cited as a reason for the teaching methods being heavily weighted towards the transfer of factual information, as distinct from the development of decision-making skills, and practical skills for childbirth and parenting The results indicate clearly that antenatal classes cannot possibly cover all there is to know about pregnancy, childbirth and parenting. If the purpose of antenatal classes is to improve maternal health literacy, then women need to leave a class with the skills and confidence to take a range of actions that contribute to a successful pregnancy, childbirth and early parenting. This includes knowing where to go for further information, and the ability to analyse information critically. The authors conclude that this would represent a very challenging change in orientation for both the educators and pregnant women included in this study. Work continues on the development of the tools that will be needed to support this change.     

Associations of Lesbian,Gay, Bisexual,Transgender, and Questioning–Inclusive Sex Education With Mental Health Outcomes and School-Based Victimization in U.S. High School Students

Purpose

Homophobic school climates are related to increased victimization for sexual minority youth (SMY), leading to increased risk of adverse mental health outcomes. Interventions that promote positive school climate may reduce the risk of victimization and adverse mental health outcomes in SMY. This study explored whether lesbian, gay, bisexual, transgender, and questioning (LGBTQ)–inclusive sex education is associated with adverse mental health and school-based victimization in U.S. youth.

农村小学校开设健康教育课的效果评价

通过对德州市三所农村小学校进行为期1年的健康教育干预及评价显示:一般干预组与对照组相比,卫生知识及信念正确回答率差异有显著性(P<0.01),而口腔卫生行为差异无显著性(P>0.05);加强干预组与对照组相比,卫生知识、信念正确回答率及口腔卫生行为差异均有显著性(P<0.01).由此可见,健康教育,尤其是结合小学生特点开展的健康教育活动是提高小学生卫生知识、信念及行为的易行有效的措施.     

Pregnancy prevention,reproductive health risk and morality: a perspective from public-sector women's clinics in St. Petersburg,Russia

The use of reliable contraception in Russia remains lower and rates of induced abortion higher than in Western Europe, even though reliable contraception has been accessible for nearly two decades now. Due to the organisation of women's health services in Russian cities, gynaecologists can have a major influence on women's contraceptive choices, but little is known about their attitudes and practices in terms of contraception promotion. This study draws on qualitative observation and interview data of gynaecologists in public-sector women's clinics in St. Petersburg, Russia's second largest city in order to investigate their perceptions of various birth control methods and contraception counselling. Also in focus are clinical counselling practices. The results reveal that gynaecologists in St. Petersburg had up-to-date knowledge of the latest contraception methods and that they were willing to promote their use. They took an active role in counselling, although the coverage was not full. The depth of counselling varied considerably and counselling practices were mainly paternalistic. Yet, in about a third of the observed cases, patient preferences were incorporated into clinical decision-making. The gynaecologists perceived reliable contraception essentially as a means of fostering future fertility and avoiding harmful health consequences of induced abortions. Using reliable contraception was equated with being a responsible and morally respectable woman. The results suggest that links between health, risk and morality are vividly present in contraception counselling in St. Petersburg, and that reliable contraception has become a powerful source of new moral demands for individual women to foster their reproductive function.     

Schools for health, education and development: a call for action

In 2007, the World Health Organization, together with UnitedNations and international organization as well as experts, metto draw upon existing evidence and practical experience fromregions, countries and individual schools in promoting healththrough schools. The goal of the meeting was to identify currentand emerging global factors affecting schools, and to help themrespond more effectively to health, education and developmentopportunities. At the meeting, a Statement was developed describingeffective approaches and strategies that can be adopted by schoolsto promote health, education and development. Five key challengeswere identified. These described the need to continue buildingevidence and capturing practical experience in school health;the importance of improving implementation processes to ensureoptimal transfer of evidence into practice; the need to alleviatingsocial and economic disadvantage in access to and successfulcompletion of school education; the opportunity to harness mediainfluences for positive benefit, and the continuing challengeto improve partnerships among different sectors and organizations.The participants also identified a range of actions needed torespond to these challenges, highlighting the need for actionby local school communities, governments and international organizationsto invest in quality education, and to increase participationof children and young people in school education. This paperdescribes the rationale for and process of the meeting and thedevelopment of the Statement and outlines some of the most immediateefforts made to implement the actions identified in the Statement.It also suggests further joint actions required for the implementationof the Statement.     

开展高校社区卫生服务的重要意义和形式内容及具体做法

根据国家医疗保障制度改革的总体目标和要求，高校医院的工作将逐步转向高校的社区卫生服务。认真研究高校社区的特点，及时解决在高校开展社区卫生服务面临的问题，积极探索在高校开展社区卫生服务的形式和内容，自觉进行高校医院结构和职能的双重改造，对全面推进高校的社区卫生服务工作，无疑具有重要的理论意义和实践意义。     

中国九城市社区、医院、企业健康教育工作现场调研报告

目的 了解北京、天津、上海、杭州、无锡、济南、武汉、保定、包头等9个城市社区、医院、企业健康教育的现状、经验及存在的问题，为制定城市社区、医院、企业健康教育工作规范及考核指标体系提供依据。方法 访谈7个市卫生局主管社区卫生工作的部门领导，9个市健康教育所负责社区健康教育工作的领导；现场考察13个三级甲等医院、11个健康教育工作开展比较好的企业、9个社区卫生服务中心和9个社区卫生服务站的健康教育工作，并在考察的医院、企业、中心(站)组织小组讨论，查阅有关件和资料。结果 9个城市都颁布了相关的件，并将社区卫生服务中心(站)的建设纳入为民办实事工作中，有关领导重视社区健康教育工作；社区卫生服务中心(站)主要有3种类型；北京、上海、杭州等市政府每年投入一定的预防保健经费；有些三级甲等医院和企业的健康教育工作开展得有特色；18个社区卫生服务中心(站)都在开展“六位一体”的服务，但缺乏健康教育专业人员；社区卫生服务中心用房面积1500m^2左右，工作人员20～140人，社区卫生服务站用房面积40～160m^2，工作人员2～16人，健康教育仍沿用老的工作模式，不能满足居民的需要。结论 城市社区、医院、企业健康教育虽然取得一些成绩和经验，但经费投入不足、补偿机制不健全，发展尚不平衡，有待加强和推动。     

农村儿童营养不良相关因素调查及干预策略探讨

为了解儿童营养不良的相关因素,探索用健康教育干预的方法控制儿童营养不良,为制定改善儿童健康的策略提供科学依据,采用健康教育干预的方法,对福建省经济发展水平不同的两个县的所抽学校的小学生进行行为干预,并对实验组和对照组的近2000名学生作问卷调查和体检,同时对其家长调查,以确定干预效果。结果发现干预前小学生及其家长的营养卫生知晓率低下,小学生营养不良率达36．8％,缺铁性贫血患病率达42．5％。经过干预,缺铁性贫血患病率下降3．7％,营养不良率下降8．6％。健康教育是改善儿童营养状况的有效手段,应加强对小学生及其家长营养知识教育和行为干预。     

Health, schooling and lifestyle among young adults in Finland

This was a longitudinal, general population study based on a Northern Finland 1966 Birth Cohort, using a structural equation approach to estimate the health production function and health input functions for four lifestyle variables (smoking, alcohol consumption, exercise and unhealthy diet) for males and females. In particular, we examined the productive and allocative effects of education on health. We used 15D, a generic measure of health-related quality of life, as a single index score measure but we also estimated models for some of its dimensions. Among the males, the important factors impacting on health were education and all the four lifestyle factors, as well as some exogenous variables at 31 years and variables describing parents' background, and health and behaviour at 14 years. An increase of five years in schooling increased the health score by 0.008, of which about 50% was due to direct effect and 50% due to indirect effects. Among the females, education does not impact on health, but health was affected by the use of alcohol, exercise and diet, but not by smoking.Our results indicate that policy options that increase education among men will increase their health indirectly via healthier lifestyles. However, since the total effect was rather modest and the direct effect insignificant, an increase of schooling is not a cost-effective way to increase health given the present high educational level of Finland. The young adults' and particularly women's internationally high educational status in Finland might be a reason why we find only a modest effect of schooling on health and the non-existence of such effects among women.     

Lymphoedema management: An international intersect between developed and developing countries. Similarities,differences and challenges

Abstract

Lymphoedema is a chronic swelling condition that contributes to disability, dysfunction and lost quality of life. Significant disparities exist worldwide regarding the availability of resources necessary to identify, treat and manage lymphoedema. This disparity transcends socio-economic status and is a common problem in both developed and developing countries. The overall impact of lymphoedema as a public health problem, however, is underestimated, principally due to the lack of epidemiologic data. These problems pose barriers to optimal identification and management of this disabling, lifelong condition.

In 1997, the World Health Organization (50.29) resolved that lymphatic filariasis should be eliminated as a public health problem. A component of this strategy focuses on disability management for those suffering from lymphatic filariasis-related morbidity. This initiative has enhanced lymphoedema awareness in developing countries. However, significant deficits persist in health care providers' knowledge, educational initiatives and basic disease identification and treatment.

In developed countries, lymphoedema continues to be an underrecognised condition and assumed to be only cancer-related. Health care resources allocated to treat and manage the disease are insufficient for basic and ongoing care, resulting in disease progression and disability. The International Lymphoedema Framework project, established in 2002, seeks to establish a consensus for best practices in the management of lymphoedema worldwide to reduce this disability burden.

A basic global construct for lymphoedema management is needed to decrease morbidity and promote optimal disease management across all cultural and socio-economic boundaries. Many countries are unaware of the importance of lymphoedema management and have not defined a national strategy with respect to this problem. The objective of this article is to define similarities and differences in strategies for lymphoedema management between developed and developing countries and advocate for a cohesive and concerted approach to disease management.     

Prevalence of multiple antibiotic-resistant Gram-negative bacteria on bagged,ready-to-eat baby spinach

In this study, multiple antibiotic-resistant (MAR) Gram-negative bacteria (GNB) were isolated from triple-washed, bagged, ready-to-eat (RTE) baby spinach. Biochemical identification of randomly selected bacterial colonies showed the predominance of cytochrome oxidase-positive Pseudomonas species. Among the GNB, a higher prevalence of resistance was observed against cefoxitin (93.1%) followed by ampicillin (79.4%), chloramphenicol (72.6%), ceftizoxime (65.7%), aztreonam (64.9%), cefotaxime (53.6%), imipenem (38.3%), ceftazidime (33.5%), gentamicin (32.6%), tetracycline (22.2%), and ciprofloxacin (19.8%). Multiple antibiotic resistance (MAR) linked to two or more antibiotics was found in 95.3% of isolates, and resistance was transferable in the strains tested. These findings confirm the presence of MAR bacteria on RTE baby spinach and suggest that human consumption of this produce would amplify the MAR gene pool via conjugal transfer of MAR genes to commensal gut microflora and bacterial pathogens.     

Unraveling the web: an evaluation of the content quality, usability, and readability of nutrition web sites

OBJECTIVE: To determine the content quality, general readability, and usability characteristics of consumer nutrition information on the World Wide Web. DESIGN: Almost 500 Web sites were identified for evaluation through 2 different approaches. Of these, 150 were included for further evaluation. Each site was rated on a 27-item tool covering content quality, readability, and usability. ANALYSIS: Summary statistics, means, ranges, and standard deviation were calculated for each study variable. The statistical significance of differences between item means by search strategy was determined using Student's t tests. RESULTS: Web sites identified using popular search engines scored significantly lower for content quality (P < .0001), were easier to navigate (P < .001), had better overall adherence to usability standards (P < .0001), and had lower reading levels compared with those sites identified using a government Web portal. CONCLUSIONS AND IMPLICATIONS: Nutrition Web sites obtained using popular search engines may be aesthetically appealing and easy to use, but they often provide inaccurate nutrition information. As consumers increasingly turn to the World Wide Web for nutrition advice and education, it is imperative that the needs of diverse user populations be identified and addressed. Future nutrition education research should build on these findings by creating strategies that help users find reliable user-friendly gateways to accurate nutrition information on the Internet.     

Bridging the gap between education and practice in public health, with particular reference to less-developed provinces in China

Ongoing healthcare system reform is one of the most important issues in China. There is an increasing awareness that public health education should be reformed to meet the demands of public health practice. This paper summarizes the current status of increasing public healthcare demand and public health service capacity in China, especially in less-developed provinces, and introduces the current public health educational system and public health administration structure. The paper also provides evidence for a considerable gap between public health education and practice, and suggests possible measures to bridge the gap.     

Health and safety education for worker empowerment.

This article introduces a special issue of the American Journal of Industrial Medicine dedicated to innovative approaches to worker education in health and safety. Contributors to this issue describe applications of an "empowerment approach" in a wide variety of institutions and settings throughout the United States and Canada. In this article, empowerment education is presented and contrasted with other training methodologies. The article offers suggestions on how to implement this approach discusses evaluation issues, and summarizes the articles contained in this issue. Explored are preliminary outcomes of using this methodology and implications for developing educational programs in the future.