Research on women and health care: Influence of sociocultural factors

Sociocultural factors and medical science have shaped the basic ideas about the female role and her place in society. This paper discusses the influence of these ideas on current thinking about women and their health and raises design and methodological questions about past research. Additionally, current research emphasis in the field of women's health is explored.     

Mozambican Midwives' Views on Barriers to Quality Perinatal Care

Our purpose in this study was to explore the midwives' perception of factors obstructing or facilitating their ability to provide quality perinatal care at a central labor ward in Maputo. In-depth interviews were undertaken with 16 midwives and were analyzed according to grounded theory technique. Barriers to provision of quality perinatal care were identified as follows: (i) the unsupportive environment, (ii) nonempowering and limited interaction with women in labor, (iii) a sense of professional inadequacy and inferiority, and (iv) nonappliance of best caring practices. A model based on the midwives' reflections on barriers to quality perinatal care and responses to these were developed. Actions aimed at overcoming the barriers were improvising and identifying areas in need of change. Identified evading actions were holding others accountable and yielding to dysfunction and structural control. In order to improve perinatal care, the midwives need to see themselves as change agents and not as victims of external and internal causal relationships over which they have no influence. It is moreover essential that the midwives chose actions aiming at overcoming barriers to quality perinatal care instead of choosing evading actions, which might jeopardize the health of the unborn and newborn infant. We suggest that local as well as national education programs need to correspond with existing reality, even if they provide knowledge that surpasses the present possibilities in practice. Quality of intrapartum and the immediate newborn care requires a supportive environment, however, which in the context of this study presented such serious obstacles that they need to be addressed on the national level. Structural and administrative changes are difficult to target as these depend on national organization of maternal health care (MHC) services and national health expenditures.     

Association between underweight and overweight/obesity with oral health among independently living Brazilian elderly

ObjectivePoor oral status, represented by partial/complete tooth loss, may lead to changes in food choice, which may ultimately lead to underweight, overweight, or obesity. The aim of this study is to evaluate whether poor oral status is associated with underweight or overweight/obesity, regardless of physical activity.MethodsThis cross-sectional study is part of a major project, The Frailty in Brazilian Elderly Study, carried out in Campinas, Brazil (2008–2009). The sample was composed of 900 independent-living older adults. Complete data were available for 875 individuals including sociodemographic, self-reported amount of medications used and eating difficulty questionnaire, smoking habit, depressive symptoms, physical activity, oral examination, and anthropometric assessments according to the WHO criteria. Body mass index was used as an outcome. Multinomial logistic regression was adjusted for confounding variables.ResultsThe mean age of the sample was 72.7 y (±5.81) and the prevalence of edentulism was 47.7%. Edentate individuals not wearing dentures were more likely to be underweight [odds ratio (OR) = 3.94, 95% confidence interval (CI) 1.14–13.64] and overweight/obese (OR = 2.88, 95%CI 1.12–7.40). Males (OR = 0.56, 95%CI 0.36–0.85) and those not using medications (OR = 0.41 95%CI 0.24–0.70) were less likely to be overweight/obese. Individuals who smoke (OR = 2.62, 95%CI 1.26–5.44) were more likely to be underweight. Older individuals with family income between 3.1 and 5 minimum wage (OR = 1.69, 95%CI 1.00–2.87) were more likely to be overweight/obese.ConclusionTo our knowledge, this is one of the first studies associating poor oral health, represented by edentulism not rehabilitated with dentures, with unfavorable body mass, regardless of the two major confounders, physical activity and depression symptoms.     

Dietary restriction interferes with oxidative status and intrinsic intestinal innervation in aging rats

ObjectivesTo evaluate the effects of dietary restriction on oxidative status, the HuC/D–neuronal nitric oxide synthase (nNOS) myenteric neuron population, HuC/D-S100 glial cells, and the morphometry of the small intestine in rats at various ages.MethodsFifteen Wistar rats were divided into 7-and 12-mo-old control groups and a 12-mo-old experimental group subjected to dietary restrictions (50% of normal ration) for 5 mo. At 7 and 12 mo of age, the animals were anesthetized, and blood was collected to assess the biochemical components and oxidative status. Ileum samples were subjected to double-marker (HuC/D-nNOS and HuC/D-S100) immunostaining and histologic processing to morphometrically analyze intestinal wall elements and determine the metaphase index and rate of caliciform cells. The data were subjected to analysis of variance and the Tukey post hoc test with a 5% significance level.ResultsAge affected the oxidative status by increasing lipid peroxidation, with no effect on blood components, intrinsic innervation, and intestinal wall elements. The animals subjected to dietary restriction showed improved levels of total cholesterol, triacylglycerols, and oxidative status, with no changes in the nNOS neuron population. However, the dietary restriction dramatically decreased the glial and HuC/D myenteric populations, led to atrophy of the neuronal cell body, induced glial hypertrophy, and decreased the thickness of the intestinal wall.ConclusionThe high oxidative status of the aging animals was reversed by dietary restriction, which also lowered cholesterol and triacylglycerol levels. The present dietary restriction elicited morpho-quantitative changes in the myenteric plexus and histology of the ileum, with likely effects on intestinal functions.     

N-acetylcysteine attenuates renal alterations induced by senescence in the rat

The aim of this study was to evaluate the effects of N-acetylcysteine (NAC) on renal function, as well as on sodium and water transporters, in the kidneys of aged rats. Normal, 8-month-old male Wistar rats were treated (n = 6) or not (n = 6) with NAC (600 mg/L in drinking water) and followed for 16 months. At the end of the follow-up period, we determined inulin clearance, serum thiobarbituric acid reactive substances (TBARS), serum cholesterol, and urinary phosphate excretion. In addition, we performed immunohistochemical staining for p53 and for ED-1-positive cells (macrophages/monocytes), together with Western blotting of kidney tissue for NKCC2, aquaporin 2 (AQP2), urea transporter A1 (UT-A1) and Klotho protein. At baseline, the two groups were similar in terms of creatinine clearance, proteinuria, cholesterol, and TBARS. At the end of the follow-up period, NAC-treated rats presented greater inulin clearance and reduced proteinuria, as well as lower serum cholesterol, serum TBARS, and urinary phosphate excretion, in comparison with untreated rats. In addition, NAC-treated rats showed upregulated expression of NKCC2, AQP2, and UT-A1; elevated Klotho protein expression, low p53 expression, and few ED-1 positive cells. In conclusion, we attribute these beneficial effects of NAC (the significant improvements in inulin clearance and in the expression of NKCC2, AQP2, and UT-A1) to its ability to decrease oxidative stress, inhibit p53 expression, minimize kidney inflammation, and stimulate Klotho expression.