Medicine and Health Sciences Commons^™

From Pilots To Regional Programs: Expanding Contraceptive Choice And Improving Quality Of Care In Zambia's Copperbelt, Jill Keesbury

Reproductive Health

Between 2002 and 2005, the Pilots to Regional Programs (PRP) initiative was implemented in eight rural and periurban districts of Zambia’s Copperbelt region. Implemented by the Zambian Ministry of Health/Central Board of Health in collaboration with the Copperbelt Provincial Health Office and with technical assistance from the Population Council, the PRP initiative had two objectives: to expand contraceptive choice and increase the availability of high-quality reproductive health services, and to field-test a model for scaling up reproductive health interventions. The resulting project was structured around three activities: (1) expanding the method mix, (2) training healthcare workers, and (3) linking the …

Increasing Dual Protection Among Rickshaw Pullers In Bangladesh, Ismat Bhuiya, Mizanur Rahman, Ubaidur Rob, M.E. Khan, K.M. Zahiduzzaman

Reproductive Health

The main objective of this study, conducted in six urban clinics of Dhaka, Bangladesh was to increase contraceptive use among rickshaw pullers, with special emphasis on condom use. The study tested two strategies to increase access to family planning and reproductive health (RH) information and services: a) an educational campaign together with improved availability of condoms; and b) an educational campaign alone. Findings show that rickshaw pullers’ knowledge on contraceptive methods increased significantly in both the experimental sites compared to the control site. Use of any contraceptive method increased significantly in the experimental sites, and condom use increased significantly in …

Consolidating A Gender Perspective In The Procosi Network, Erica Palenque De La Quintana, Patricia Riveros Hamel, Ricardo Vernon

Reproductive Health

The Integral Health Coordination Program (Programa de Coordinación en Salud Integral, or PROCOSI) in Bolivia developed a program to certify service delivery and management support NGOs as gender-sensitive. The certification system is based on an initial self-assessment by teams consisting of staff from service delivery (clinical) or management support (administrative) NGOs, followed by the development and implementation of activities to improve the gaps found until a minimum of 80 percent of the designated quality and gender standards are met. At the project’s end, 14 of the 15 participating NGOs had reached compliance with at least 80 percent of the proposed …

Strengthening Financial Sustainability Through Integration Of Voluntary Counseling And Testing Services With Other Reproductive Health Services, Rumeli Das, Kaushik Biswas, Pradeep Panda, M.E. Khan, Rick Homan

Reproductive Health

In West Bengal, India, the Child in Need Institute (CINI) operated an HIV/AIDS voluntary confidential counseling and testing center and a reproductive health clinic at separate locations. Concerns about lack of service coordination as well as cost and revenue considerations led CINI to integrate the two services. CINI conducted an operations research study to examine the impact of integration on utilization and revenues. The objective of the study was to examine whether integration of services would yield an increase in clients served and improve the financial position of the program. The study found that integrating services was associated with increased …

Provision Of Emergency Contraceptive Services Through Paraprofessionals In India, Shiv Kumar, Chander Shekhar, N.K. Gupta, Malabika Roy, M.E. Khan, Mary Philip Sebastian, Rukma Idnani, Ardash Bhargava, Vinita Salvi

Reproductive Health

In 2004, with funding for technical assistance provided by USAID, the Indian Council of Medical Research funded and collaborated with the Frontiers in Reproductive Health (FRONTIERS) program of the Population Council on a two-year study to assess the usefulness and effectiveness of using paraprofessionals in educating and providing emergency contraception (ECP) services to potential users. Based on the findings and advocacy efforts, the Indian Ministry of Health and Family Welfare introduced ECP as an over-the-counter medication beginning in September 2005. This made it possible for paraprofessionals in the National Family Planning Program to provide ECP services, making the method widely …

Developing And Testing Strategies For Increasing Awareness Of The Iud As A Contraceptive Option, Ricardo Vernon, M.E. Khan, Harriet Birungi, Ian Askew, William Stones

Reproductive Health

A workshop was held in England in 2004 to identify the most promising interventions for increasing access to the IUD and to generate protocols for small-scale operations research projects to be undertaken in selected countries. Participants were academics, policymakers, program staff, and service providers from Bangladesh, Ghana, Guatemala, Honduras, India, Kenya, and Nepal. The workshop objectives were to review international experiences with approaches to increase access to and use of the IUD; identify factors explaining the decline in IUD use in many countries; identify factors favoring client demand for IUD; review barriers to effective IUD service delivery; identify issues of …

Technical Assistance To The Institute Of Reproductive Health, Georgetown University In Researching Introduction Strategies For The Standard Days Contraceptive Method (Sdm), Saumya Ramarao, James R. Foreit

Reproductive Health

The Institute of Reproductive Health (IRH), Georgetown University tested the impact of introducing the standard days contraceptive method (SDM) with the technical assistance (TA) of Population Council staff. FRONTIERS technical assistance had the immediate effect of allowing IRH to carry out evaluations of the SDM in Asia and Latin America. The IRH studies also produced important lessons learned on strategies for the introduction of natural methods. IRH staff responsible for the India and Ecuador projects learned specific skills in cost-analysis and research instrument design.

Effect Of Introducing An 'Afternoon Pay Clinic' On Service Utilization And Cost Recovery (Nepal), Mahendra Pd. Shrestha, Rajesh Swar, Pradeep Panda, M.E. Khan, Rick Homan

Reproductive Health

An operations research study was initiated with financial and technical assistance from the FRONTIERS program to examine whether introducing an afternoon clinic at the Chhetrapati Family Welfare Center (CFWC) in Nepal with a substantially higher registration fee could improve cost recovery by adding more to program revenues than to program costs. The study showed, however, that premium pricing of afternoon services generated very little additional demand for services. Even with a premium price, the afternoon clinic could reach its cost recovery goal only if the volume of afternoon clients were to increase significantly. However, client perceptions about the ability of …

Assessing The Feasibility, Acceptability And Cost Of Introducing Postabortion Care In Health Centres And Dispensaries In Rural Tanzania, Monica Wanjiru, Ian Askew, Nzoya Munguti, Saumya Ramarao, Rick Homan, Reheme Kahando, John M. Pile

Reproductive Health

The EngenderHealth ACQUIRE Project has been supporting the Tanzanian Ministry of Health (MOH) since early 2005 to decentralize the management of postabortion care (PAC) services to primary healthcare facilities (health centers and dispensaries), with the intention of bringing services closer to women who are unable to access them at district hospitals. Findings from this study were provided to the MOH and ACQUIRE to address issues arising from introduction of the intervention; and in September 2006, to assess the feasibility, cost, and effectiveness of the intervention. Findings show that the intervention appears to have broadened service providers’ range of clinical skills …

Testing The Effectiveness Of The Men As Partners Program (Map) In Soweto, South Africa, Prudence Ditlopo, Saiqa Mullick, Ian Askew, Ricardo Vernon, Edwin Maroga, Sgidi Sibeko, Mokgethi Tshabalala, Rabbuh Raletsemo, Dean Peacock, Andrew Levack

Reproductive Health

This project was conducted to evaluate the effectiveness of the Men as Partners (MAP) program in South Africa in terms of: changing men’s gender attitudes, norms and behaviors; changing aspects of gender dynamics in relationships; reducing the prevalence of unwanted pregnancy risk behaviors at individual and community levels; and increasing male involvement in gender based violence (GBV) and HIV prevention and in HIV care and support activities. The intervention activities implemented were MAP workshops, public demonstrations, and participation in community action teams. The evaluation of the interventions showed that about 30% of the workshop participants had also attended other MAP …

Addressing The Needs Of Seasonal Migrants In Nashik, Maharashtra, Anjali B. Borhade

Reproductive Health

In order to identify the opportunities and options available to address the vulnerabilities of and socioeconomic needs of seasonal migrants, an intervention project was launched by the Disha Foundation, a nongovernmental organization in Nashik city, Maharashtra, India. This report intends to use the project experience as a case study to provide a blueprint for interventions for seasonal migrants to access a range of basic services in areas of destination and to exercise their rights to access available services. The report documents the array of strategies used to enable seasonal migrants to recognize their entitlement and to access available public sector …

Informed Consent In Sterilisation Services: Evidence From Public And Private Health Care Institutions In Chennai, Raja Lakshmi

Reproductive Health

The objective of this paper is to explore the experiences of women undergoing a particular form of fertility regulation, namely sterilization or tubal ligation, in a variety of facilities in Chennai, India. The paper examines specifically the nature of information provided to clients, the consent-taking process, the nature of its documentation, and the extent to which clients made an informed choice. The findings underscore that although all the women respondents did wish to practice a method of contraception, and did want to adopt sterilization, several limitations were noted in the process of providing informed consent: inadequate information was provided to …

Young People's Sexual And Reproductive Health In India: Policies, Programmes And Realities, K.G. Santhya, Shireen J. Jejeebhoy

Reproductive Health

This paper presents an overview of key policies and government programmes intended to reduce HIV vulnerability and improve sexual and reproductive health among young people in India, and identifies the extent to which these policies and programmes have addressed the gamut of unique sexual and reproductive needs of young women and men. It also explores the extent to which programmes have been adapted to accommodate state-level differences in the sexual and reproductive vulnerability of youth; the review takes the examples of two states, namely, Andhra Pradesh, characterised by both early marriage and high HIV prevalence, and Madhya Pradesh, characterised by …

From Adulterous Gametes To Heterologous Nation: Tracing The Boundaries Of Reproduction In Italy, Milena Marchesi

Reconstruction: Studies in Contemporary Culture

This article traces discursive and political attempts to discipline the reproduction of the Italian nation by analyzing the approval of a controversial law disciplining access to new reproductive technologies (NRTs) in 2004. The restriction of new reproductive technologies in Italy reflects a contemporary re-negotiation of gender ideologies and a renewed ascendance of the Vatican in Italian politics and society. Although abortion remains legal in Italy, the NRT legislation recognizes the embryo as a subject while in political discourse demographic alarmism slides into warnings of social disintegration. The debate over the threat posed by technologically assisted reproduction to Italian families and …

Health Systems And Maternal Mortality, Neonatal Mortality And Child Health: Review Of Selected Service Delivery Models, Md. Noorunnabi Talukder, Ubaidur Rob

Reproductive Health

Effective maternal and child health services at the community level in developing countries are rarely available. In many developing countries the health systems cannot provide quality maternal and child health care services due to lack of adequate human resources; shortages of equipment, drugs, and supplies; and absence of proper referral mechanisms. Strengthening health systems is central to improving maternal and child health. A variety of targeted interventions have been implemented in the health systems of developing countries. This study was conducted to identify the health service delivery models that have contributed to the reduction of maternal, infant, and child mortality …

Kenya: Begin Community Dialogue On Fgm/C By Discussing Cultural Justification, Frontiers In Reproductive Health

Reproductive Health

Female genital cutting is strongly supported among the Somali ethnic community in Kenya, and the severest form (infibulation) is primarily practiced. This type of cut is associated with increased incidence and seriousness of obstetric and gynecological problems relative to uncut women and those with less severe forms of FGM/C. As stated in this brief, efforts to encourage abandonment should begin with community discussion about the socio-cultural reasons for cutting. Simultaneously, health-care providers need training in how to manage complications of FGM/C. In 2004, FRONTIERS collaborated with UNICEF on a four-month diagnostic study on FGM/C practices among the Somali community in …

Senegal: Mainstreaming Adolescent Health: Building On Local Support Systems, Frontiers In Reproductive Health

Reproductive Health

In 1999, FRONTIERS began a three-year collaboration with the World Health Organization, the Center for Research and Training, the Population Training Group, and the Ministries of Health, Education, and Youth to test the feasibility, effectiveness, and cost of school-, clinic-, and community-based interventions to improve the reproductive health of youth aged 10–19. This adolescent reproductive health (ARH) study showed that the multisectoral, multidisciplinary approach increased knowledge about youth reproductive health among young people, the community, schools, and health-care providers. As noted in this brief, one of the guiding principles of the ARH study was to build sustainability through existing institutions, …

An Exploratory Study Of Pet Raising And Health Of The Elderly People In Hong Kong, Cheung Ming, Alfred Chan, Kam Wing, Kevin Cheung, Lam Fat Lo

APIAS Monograph 專題論文

Introduction:

Pets such as dogs, cats and fish were popular in many other countries (Marx et al., 1988; Gammonley, 1991; Brodie & Biley, 1999; PIAS, 2002). In Hong Kong, pet owners increased to 0.26 million (Census and Statistics Department, 2006). Dating back to 1980s, a research study reported the association between pet ownerships and health benefits for humans (McNicholas et al., 2005). According to the report, domesticated pets brought a sense of companionship and provided pet owners with pleasure. These pets could be tools for enhancing human social relationship and could also provide their owners with emotional comfort. Recent studies …

Does Verbal Communication Impairment Affect Quality Of Life In Amyotrophic Lateral Sclerosis Patients?, Jason Michael Duff

PCOM Psychology Dissertations

The purpose of this study was to examine the self-perceived QOL in ALS patients. Literature will be presented on the incidence, prevalence, prognosis, diagnosis and management of ALS, QOL studies for ALS, the role of the multidisciplinary team, the impairments and dysfunction that ALS patients experience, communication issues, and the development of ALS specific instruments to measure QOL. The "bulbar dysfunction" that ALS patients experience in salivation management, speech, and swallowing were examined in detail. The objectives of this research study were to investigate the following hypotheses: 1. QOL will differ among ALS patients with varying levels of speech, swallowing, …

Teaching Parenting Skills In A Methadone Treatment Setting, Randy R. Gainey, Kevin P. Haggerty, Charles B. Fleming, Richard F. Catalano

Sociology & Criminal Justice Faculty Publications

Family factors significantly affect children’s risk of substance abuse, delinquency, and other problem behaviors (Arthur, Hawkins, Pollard, Catalano, & Baglioni, 2002). Children of substance abusers represent a particularly high-risk population. Prenatal exposure to addictive substances and the medical complications that may arise are important factors that, from conception, place this population at high risk of drug abuse and other problem behaviors (Griffith, Azuma, & Chasnoff, 1994). As children of substance abusers mature, their lives are characterized by exposure to continued drug and alcohol abuse by family members, recurrent or chronic illnesses, frequent moves, financial troubles, legal conflicts, family disorganization, and …

Episiotomy And Obstetric Trauma In Nevada: Evidence From Linked Hospital Discharge And Birth Data, Gulzar H. Shah, Joseph A. Greenway, Wei Yang

Nevada Journal of Public Health

Based on the perception that episiotomy prevents obstetric trauma, the procedure is liberally performed in U.S. Hospitals. Using linked Nevada Birth Registry and Nevada Impatient Hospital Discharges (2000 to 2005), we applied descriptive analyses and logistic regression to examine the status of Nevada episiotomy practice and its impact on birth trauma for mothers. Of 106,461 vaginal live births, 26,383 (24.8%) episiotomies were conducted. Obstetric trauma rate declined from 5.2% of vaginal deliveries in 2000 to 4.4% in 2005. After statistically controlling for the effect of other risk factors, zero parity, episiotomy, other instrument assisted deliveries, non-MDs as birth attendants, rural …

Las Vegas: A Sustainable Urban Environment For Health?, Nancy Menzel

Nevada Journal of Public Health

The rapid growth of Las Vegas has resulted in negative consequences for the health of its residents to a level that threatens the area’s sustainability. This article reviews key indicators of population health in Las Vegas through the framework of the US Centers for Disease Control and Prevention’s Healthy People in Healthy Places and concludes that public health professionals, citizens, businesses, and political leaders must act now to protect and improve population health.

Book Review: Social Justice: The Moral Foundations Of Public Health And Health Policy, Robin West

Georgetown Law Faculty Publications and Other Works

This essay is a review of Social Justice: The Moral Foundations of Public Health and Health Policy by Madison Powers & Ruth Faden (2006).

In this pathbreaking book, senior bioethicists Powers and Faden confront foundational issues about health and justice. How much inequality in health can a just society tolerate? In a world filled with inequalities in health and well-being, which inequalities matter most and are the most morally urgent to address? In order to answer these questions, Powers and Faden develop a unique theory of social justice that, while developed for the specific contexts of public health and health …

The Latino Caregiver Experience Among Dementia And Non-Dementia Caregivers : Can Community Based Care Management Improve Caregiver Health?, Catherine Oliveros

Loma Linda University Electronic Theses, Dissertations & Projects

Purpose: This study provides an analysis of the Latino caregiving community in Southeast Texas and the role community based care management plays in influencing caregiver physical and emotional well-being. Design and Methods: A non-random sample of 63 Latino caregivers was interviewed by phone. Caregiver physical and emotional well-being was studied through burden, depression, perceived health status, and resourcefulness. Regression, correlation, and comparison analysis was performed with key variables. Results: Acculturation was positively correlated with care management use. In comparing dementia and non-dementia caregivers both groups had similar levels of depression and burden, however, the dementia group had significantly lower levels …

Paved With Good Intentions: A Definitional Study On The Issue Of Psychological Child Abuse, Anita Renee Fromm

Graduate Theses

Definitional issues concerning child abuse have long plagued the identification and treatment of this malady. This study examined the role of perpetrator intention in categorizing adverse parenting skills, as well as psychological child abuse potential. Exploitative parenting styles were displayed and rated in a variety of vignettes. Social service professionals and university students were participants in this vignette style questionnaire study. Results indicated that with a few exceptions, a constant perpetrator intention did not appear to alter subject perceptions that the scenarios presented adverse parenting skills and child abuse potential. The participants were indecisive concerning scenarios that represented excessive athletic …

The Qingdao Twin Registry: A Focus On Chronic Disease Research, C. Anderson Johnson, Zengchang Pang, Feng Ning, Jennifer B. Unger, Shaojie Wang, Qian Guo, Weihua Cao, Liming Lee

CGU Faculty Publications and Research

With the changing patterns of morbidity and mortality in China, noncommunicable chronic diseases have become the major threats to the health of the Chinese population. The causes of chronic diseases include genetic factors and behavioral risk factors such as the use of tobacco, alcohol, and other drugs, unhealthy dietary behaviors, and lack of physical activity. Twin studies offer a unique opportunity to disentangle the genetic and environmental risk and protective factors for chronic disease. The Qingdao Twin Registry (QTR) was initiated in 1998 as part of the National Chinese Twin Registry. Over 11,000 pairs of twins and multiples of all …

The Aggression Questionnaire As An Indicator Of Anger Expression By Abused Women In Therapy, Audrey Steakley

Graduate Theses

The present study examined whether adult women in therapy who have been physically abused express anger differently than their counterparts who have been sexually abused, and whether they are aware that they express anger in noticeable ways. The first hypothesis stated that physically abused women express anger directly and physically, whereas sexually abused women express anger indirectly, avoiding direct confrontation. The second hypothesis proposed that they are not aware how much they express their anger outwardly. Participants were female clients at a local counseling agency, with issues stemming from physical and/or sexual abuse. They voluntarily completed the Aggression Questionnaire (AQ) …

Nineteenth Century Review Of Mental Health Care For African Americans: A Legacy Of Service And Policy Barriers, Tony B. Lowe

The Journal of Sociology & Social Welfare

The need to focus on service and policy barriers to mental health service delivery for African Americans remains critical. The purpose of this article is to review nineteenth century care as a method for understanding contemporary service and policy barriers. A case study strategy is used to compare the efforts of Pennsylvania and South Carolina using primary and secondary sources to document these developments through a political economy perspective. These findings suggest that the prevailing social, political and economic realities have created mental health disparities along racial lines. Existing barriers are likely rooted in this same reality.

The Use Of Critical Ethnography In Managed Mental Health Care Settings, Cassandra L. Bransford

The Journal of Sociology & Social Welfare

How social workers in managed mental health care settings exercise their professional authority may have profound consequences for the provision of ethical and value-based services to vulnerable populations. Building upon Gidden's theory of structuration, this article describes the use of critical ethnography as a specific research methodology that may support social workers in the exercise of their authority. This article examines the historical roots of critical ethnography and provides a detailed examination of its underlying assumptions and research procedures. The article concludes with a case example of a critical ethnography conducted within a managed mental health care setting.

An Art Therapy Intervention To Help Military Children Cope With Parental Deployment, Eleanor Kai Lampell

EVMS School of Health Professions Theses & Dissertations

Research regarding military children and their ability to cope with parental deployment is extensive. However, research dealing with art therapy and military children is limited. The purpose of this study was to explore the benefits of participating in group art therapy interventions for military children with a parent currently on deployment. Five group art therapy sessions were conducted with two military children with a parent currently in stage two of parental deployment. It was hypothesized that through participating in group art therapy, military children with a parent who is currently deployed would have a reduction of problematic behaviors in a …