Analysis of Contraceptive Knowledge among MarriedReproductive Women in China

Objective To investigate how well the married reproductive women in China have the contraceptive knowledge and its influencing factors Data & Methods The data derived from "The national survey on population and re productive health in 1997" executed by State Family Planning Commission (SFPC) were analyzed. Results It showed that the contraceptive knowledge of married reproductive women was poor in China. Only 5. 9% of women got full mark (4 points) in the survey and 42. 5% of them got zero. In this survey, married reproductive women got lower marks were those who were older, in rural area, with low education levels themselves and their husbands; with a non-Hah husband, later menarche onset and earlier marriage; who had never received gynecological examination, or courses for newly married. Conclusion Spreading contraceptive knowledge among married reproductive women should be one of the central missions of family planning services in future. The focus should be put on those women we mentioned above. Regular gynecological examinations should be carried out and the education for newly married people should be more effi cient. When the courses of contraceptive knowledge are provided, both husband and wife should attend.     

Prospective Recruitment of Women Receiving Prenatal Care from Diverse Provider Arrangements: A Potential Strategy

Objectives: This study describes the use of a Medicaid managed care list to prospectively recruit into a research project pregnant women receiving care from a variety of providers. Method: A list of women enrolled in Medicaid managed care was used to recruit pregnant African-American and Latina women into a study of prenatal care satisfaction. Due to privacy concerns, the researchers were not able to directly access names from the list. Instead, a managed care contract agency sent recruitment letters to 1009 pregnant African-American and Latina Medicaid recipients. Response rates by ethnicity and several other key variables are calculated. The biases associated with this method of recruiting pregnant women from a variety of providers are discussed. Results: Thirty-five percent of the women contacted returned consent forms and agreed to have researchers approach them; the response rate for African-American women was 43% and for Latinas was 29% (p < 0.0001). Respondents were younger and later in their pregnancies than nonrespondents, but did not differ from them by zip code of residence. The women recruited into the study obtained prenatal care from a diverse group of providers. Conclusions: While the use of a prospectively generated list of pregnant Medicaid recipients to recruit low-income pregnant women into a research study may be associated with some selection bias, the potential cost savings, decreased effort, and diminished recall bias may make their use a feasible sampling alternative, particularly when the researcher desires to recruit women seeking care from a variety of provider arrangements.     

Receipt of Recommended Prenatal Interventions and Birth Weight Among African-American Women: Analysis of Data from the 1988 National Maternal and Infant Health Survey

Objectives: While the importance of exploring and better measuring elements of prenatal care have been noted in the public health literature, the components and timing of such services have been poorly examined for the overall pregnant population and specifically for African-Americans, who traditionally have had higher rates of low birth weight and premature delivery. This study explores the association between patient receipt of selected recommended prenatal care interventions and infant birth weight in a nationally representative sample of African-American women, while controlling for the influence of low birth weight risk indicators. Method: This is a retrospective case-control analysis using survey data of women who delivered normal birth weight, moderate low birth weight, and very low birth weight newborns in 1988. A sample of 3905 African-American women who responded to the 1988 National Maternal and Infant Health Survey is examined based on maternal recall of receipt of six clinical screening procedures and seven health-promotion recommendations. Birth weight measures were obtained from linked 1988 birth certificate data. Results: The initial results indicated that women who do not receive all of the recommended health-promotion advice are more likely to deliver very low birth weight infants than women who receive all of the advice in the content of their prenatal care, after controlling for low birth weight risks (OR = 1.28; 95% CI = 1.01, 1.7). However, when breast-feeding advice is removed from the aggregation of health-promotion advice, the significant effect of advice on very low birth weight is negated. No other significant group variations in the receipt of clinical screening procedures or health-promotion advice for women who gave birth in the remaining birth weight categories are observed. Conclusions: Nationally recommended initial clinical screening procedures and health-promotion advice in prenatal care content do not appear to be associated with a reduction in low birth weight for African-American women. More research is needed to better assess the impact of other antenatal interventions, particularly those given to women with a higher prevalence of poor birth outcomes.     

“Nowadays it isn't easy to advise the young”: Grandmothers and granddaughters among Abaluyia of Kenya

Among Abaluyia of Kenya relative age (seniority) structures relationships hierarchically among co-wives, siblings and females of different generations. Ambiguous equality and affectionate informality in grandmother-granddaughter relationships mute the hierarchical implications of their different age and generation statuses. This facilitates grandmothers' educational roles although, as grandmothers say, Nowadays it isn't easy to advise the young. Increased physical, cognitive and experiential distances between these generations resulted from radical changes in the female lifecourse associated with modernization and delocalization. Nevertheless, reciprocal exchanges continue. Granddaughters are also intermediaries in exchanges between older women and their adult daughters. Some grandmothers are denied the companionship and assistance of granddaughters caught in the middle of mother-in-law/daughter-in-law conflicts. Many grandmothers assume parental responsibilities as they deal with the modern problem of daughters' premarital pregnancies. All in all, these intergenerational relationships reveal both cultural persistence and the effects of social change, and continue to have instrumental and expressive value for both grandmothers and granddaughters.     

Being in charge: Older women and their younger female kin

Our cross-cultural study of the relationship between older women and their younger female kin examines women's hierarchies based on age and focuses on the exercise of authority by women, when such authority is traditional and accepted. Data were collected for two world-wide samples each consisting of 30 societies, varying in complexity, subsistence base, geographic location, and in customs related to women's lives. Three hypotheses were tested. The findings, which are statistically significant, suggest that the relationships between older women and their younger female kin are patterned and predictable, determined by the role of women in subsistence activities, by rules for post-marital residence, and by descent.When domination can only be exercised... directly, between one person and another, it can not take place overtly and must be disguised under the veil of enchanted relationships, the official model of which is presented by the relations between kinsmen.The gentle, invisible form of violence, which is never recognized as such... can not fail to be seen as the most economical mode of domination...The system is such that the dominant agents have a vested interest in virtue. (Bourdieu 1991191, 192, 194)     

Age-related differences in breast cancer treatment

Background: More than half of the cases of breast cancer treated in the United States occur in women over age 65. This study investigates age-related differences in breast cancer therapy. Methods: A retrospective review of all women with primary operable invasive breast cancer treated at the University of Michigan Breast Care Center over a 30-month period showed a total of 77 older patients aged 65 years (median, 71; oldest patient, 92) for whom full information was available regarding comorbidity, tumor stage and histology, and details of surgery, radiation, and chemohormonal therapy and complications. Fifty-one similar younger patients aged 55–64 years (median, 59) were identified for comparison. Patients were classified as either having received standard treatment or nonstandard treatment. Standard therapy was prospectively defined as follows: local/regional—lumpectomy and axillary lymph node dissection plus radiation therapy or modified radical mastectomy; systemic—chemotherapy and/or tamoxifen for stage II disease. A comorbidity score calculated for each patient assigned one point each for nursing home residence, nonambulatory status, recent surgery, and each medical problem requiring drug therapy. Results: When overall treatment (local/regional plus systemic) was assessed, proportionately fewer older patients (55 of 77 versus 47 of 51;p<0.01) received standard treatment. Fewer older than younger patients (62 of 77 versus 50 of 51;p<0.01) received surgical therapy that included an axillary dissection. A smaller proportion of older patients received radiation therapy following lumpectomy and axillary lymph node dissection (26 of 29 versus 19 of 19; N.S.). Overall, only 59 of 77 older patients versus 50 of 51 younger patients (p<0.001) received standard local/regional care. Similar proportions of younger and older patients (19 of 22 and 24 of 30, respectively) received standard systemic therapy for stage II breast cancer, but older patients were less likely to receive chemotherapy than younger patients (7% versus 50%;p<0.001). Treatment-related complications were not age-related but were more frequent in patients receiving standard treatment than in patients receiving nonstandard treatment (45 of 102 versus two of 26;p<0.001). Comorbidity score correlated with the use of nonstandard therapy but not with age. The scores for both older and younger patients receiving overall standard treatment were 0.8 versus 1.5 and 1.4, respectively, in patients receiving nonstandard treatment. Interestingly, explanations for decisions to deviate from standard treatment guidelines were often not identified. Comorbidity was explicitly noted in only one of four younger patients who received nonstandard treatment therapy. In 22 older patients who received nonstandard treatment, comorbidity was cited in eight cases, patient age was cited in six cases, and patient choice was cited in four cases. Follow-up (median, 34 months) did not show that disease-free or overall survival differences were related to age or to treatment (standard versus nonstandard). Conclusions: These data demonstrate age-related variations in breast cancer treatment in a multidisciplinary breast care unit. Lower complication rates and equivalent short-term outcomes in women who received nonstandard therapy suggest good clinical judgment may have played a role in these differences. Although age-related patient preferences and comorbidity are relevant, the age-related attitudes of caregivers must also be taken into account to fully explain these variations.Presented at the 46th Annual Cancer Symposium of the Society of Surgical Oncology, Los Angeles, March 18–21, 1993.     

Psychological intervention with couples after mastectomy

Cancer is a family affair. Clinical work and research studies have shown that cancer does indeed invade the entire family, and that family members, especially spouses, are often highly distressed individuals. The familiy in general and the spouse in particular cannot, therefore, be looked on as natural supporters for cancer patients, but rather as a system that is itself in need of help and support.Presented at the Symposium Psychotherapeutic Interventions in Cancer Patients, Flims, Switzerland, 12–14 January 1995     

Natural helping functions of lay health advisors in breast cancer education

Summary The Save Our Sisters Project builds on the roles of 95 natural helpers to increase mammography screening among older African American women in a NC county. Natural helpers are lay people to whom others naturally turn for advice, emotional support, and tangible aid. Findings from 14 focus group interviews showed that older women seek out these individuals when they have a female-specific concern, rather than or before seeking help from professionals. The characteristics of natural helpers, revealed in the findings, were used to identify and recruit them to become trained lay health advisors in breast cancer education. Through the SOS Project, natural helpers provide a community-based system of care and social support that complements the more specialized role of health professionals; linking them to women through places and ways that no health professional could begin to acquire. The three roles of lay health advisors are: (1) to assist individuals in their social networks with needs that are difficult for professionals to address; (2) to negotiate with professionals for support from the health system; and (3) to mobilize the resources of associations in their community to sustain support from the health system.     

Barriers to Prenatal Care for Mexican and Mexican American Women

Despite the presumed health benefits, Latinas are less likely than women from other ethnic groups to receive adequate prenatal care during their pregnancy. However, it is unclear whether this trend is the result of political economic conditions that limit access of many Latinos in the United States to adequate health services in general, or of sociocultural conditions that restrict the use of such services even when they are made available. Furthermore, it is unclear whether these barriers pose a risk for adverse birth outcomes in this population. To address these issues, we conducted a two-phase study of the political economic and sociocultural barriers to use of prenatal care services among Mexican and Mexican American women living in San Diego, California, and their association with adverse birth outcomes in this population. A quantitative assessment of information abstracted from the medical records of 173 Latinas who had given birth at a university medical center found that absence of Medi-Cal benefits or other forms of health insurance was the only significant predictor of inadequate prenatal care during pregnancy. However, neither lack of insurance nor adequate prenatal care was associated with any adverse birth outcomes. A qualitative analysis of information obtained from interviews of 30 Latinas receiving prenatal care services at a medical clinic for the homeless and medically underserved residents of San Diego identified three major themes underlying the lack of adequate prenatal care: lack of trust in formal versus informal institutions, wanted versus unwanted pregnancies, and the importance of the social network.     

Coronary Health Issues for Lesbians

Since coronary heart disease (CHD) is the leading cause of death in American women it is therefore likely the leading cause of death among lesbians. Prevention of CHD is a major health issue for lesbians. Efforts must continue to empower all lesbians to take personal preventative action to prevent CHD. Women in general do not believe they are at risk for CHD. A common misperception is that CHD is a man's disease and the most likely threat to a woman's life is breast cancer. This misperception probably exists among lesbians as well. Over a lifetime, a woman is 10 times more likely to develop CHD than she is breast cancer. Breast cancer remains an important health concern for woman, but CHD risk must be addressed with potent educational and advocacy programs for the health of our communities. Prevention of the clinical manifestations of CHD hinges upon the prevention of plaque formation. It is an obligation of primary care providers to give advice regarding the prevention of plaque formation and therefore the prevention of subsequent CHD events and to collaborate with patients to address these issues in an individually tailored manner. This review addresses risk factors for CHD in lesbians to assist providers in achievement of that goal.