Managed care and reproductive health

Managed care poses special challenges to midwives providing reproductive health care. This is owing to the sensitive nature of issues surrounding reproductive health and aspects of managed care that may impede a woman's ability to obtain continuous, confidential, and comprehensive care from the provider of her choice. Variations across payers (ie, Medicare, Medicaid, and commercial insurers) regarding covered benefits and reimbursement of midwifery services also may create obstacles. Furthermore, some physicians and managed care organizations are embracing policies that threaten the ability of midwives to function as primary health care providers for women. Despite these hurdles, midwives have the potential to remain competitive in the new marketplace. This article underscores the importance of being knowledgeable about legislation and policy issues surrounding the financing of midwifery services, quality performance measurement for HMOs as they pertain to reproductive health, and discussions regarding which clinicians should be defined as primary care providers.     

Social support, activity, and health among the elderly]

The present study examined the relationship between social support, activity level and physical health among a sample of 96 Puerto Rican elderly persons. The Spanish version of the Inventory of Socially Supportive Behaviors (ISSB28) was used to assess social support. Two structured questionnaires were administered to obtain measures of activity level and physical health. A multiple correlation-regression analysis was performed, and partial correlation coefficients were also obtained. A partial correlation of .48 (p < .001) was observed between the ISSB scores and the measure of physical health, indicating a direct relationship between poor health and social support. This finding is inconsistent with previous studies, which suggest that better health is associated with higher levels of social support. Moderate-low, negative correlations were found between activity level and 3 indicators of poor health. Thus, higher activity levels were associated with better physical health. For example, partial correlations of-.31 (p = .003) and -.29 (p = .007), respectively, were found between the activity level and the number and length of hospital stays. The correlation between the amount of surgical interventions undergone by the patient during the previous year and the activity level was -.28 (p = .009). These findings demonstrate that higher levels of activity are associated with better physical health in elderly persons, as indicated by less frequent and shorter hospital stays, and lower frequency of surgical interventions. Several multiple regression analyses showed that social support and activity level, taken together, are statistically significant predictors of the number and length of hospital stays, and the number of surgical interventions undergone by the elderly patient. Together, these two factors explain from 11 to 18% of the variability in several indicators of physical health.     

Nutrition in reproductive health

BACKGROUND: Electrophysiological abnormalities during ischaemia and increased heart rate may influence the detection of ventricular late potentials in the surface electrocardiogram. Whether the analysis of functional changes adds information to the risk stratification of patients prone to ventricular tachycardia is unclear. METHODS: We therefore retrospectively investigated 100 selected patients (25 with documented, sustained ventricular tachycardia (< 230/min) ( = VT group), 25 resuscitated from ventricular fibrillation (VF group) and 50 without ventricular arrhythmias (phi VT/VF group)) in the chronic phase after myocardial infarction. Late potential analysis was performed at rest, during atrial pacing at a rate of 100/min and 120/min (n = 60), during and after occlusion of the coronary artery for coronary angioplasty (PTCA) (n = 70), and immediately after maximum exercise using selective signal averaging. RESULTS: At rest in 72% of patients in the VT group, in 32% of the VF group, and in 6% of the phi VT/VF group late potentials could be found. During atrial pacing in 80% of patients in the VT group, in 72% of the VF group, and in 10% of the patients in the phi VT/VF group and during ischaemia because of occluded coronary artery in 86% of patients in and the VT group, 70% of the VF group, and in 20% of the patients of the phi VT/VF group late potentials were present. Immediately after maximum exercise which let both ischaemia and increased heart rate, late potentials were detectable in 92% of patients in the VT group, 80% of the VF group, and in 14% of patients in the phi VT/VF group. Similar results could be achieved by using the Holter-ECG after exact correction of recorder tape speed variations. 62% of patients with only by ischaemia, increased heart rate or exercise provokable late potentials and all patients with preexistent not by PTCA extinguished late potentials developed recurrent ventricular tachycardias during the one year follow-up period. Patients without late potentials (n = 50) and patients with preexistent by PTCA extinguished late potentials (n = 11) had no recurrent ventricular tachycardias. Cycle length of recurrent and clinical tachycardia in patients with preexistent not by PTCA extinguished late potentials (n = 18) were significantly longer than in patients with only provokable late potentials (n = 21). CONCLUSIONS: Analysis of functional changes of ventricular late potentials with exercise or in Holter ECG recordings promises considerable improvement of postinfarction risk stratification especially in patients prone to ventricular fibrillation.     

Childbearing, reproductive control, aging women, and health care: the projected ethical debates

We have examined the effects of an integrin-binding competitor, echistatin, in solution on adhesion and migration of rat microvessel endothelial cells on fibronectin in vitro. A biphasic dependence of cell motility on fibronectin surface density was observed, with a peak random motility coefficient of about 8 x 10(-9) cm2/sec occurring below 0.3 microgram/cm2 fibronectin. In the presence of echistatin at 0.5 microM, the peak random motility coefficient was similar but occurred at the significantly greater fibronectin surface density of 1.2 micrograms/cm2. Hence, the same concentration of this soluble integrin-binding competitor inhibited migration on low fibronectin densities but enhanced migration on high fibronectin densities. At the same time, echistatin decreased adhesiveness on all fibronectin surface densities. When motility was correlated explicitly with adhesiveness, a single biphasic relationship was obtained for both absence and presence of echistatin with peak motility occurring in both cases at identical adhesiveness. Both the inhibiting and enhancing effects of the soluble integrin-binding competitor on motility are predictable from its effect on adhesion, consistent with the theoretical models of Lauffenburger (15) and DiMilla et al. (3).     

Husbands' reproductive health knowledge, attitudes, and behavior in Uttar Pradesh, India

To enhance the reproductive health status of couples in developing countries, the knowledge, attitudes, and behavior of both women and men must be investigated, especially where women depend on men for the decision to seek care. This study analyzes data from a survey of 6,727 husbands from five districts in the northern state of Uttar Pradesh, India. Data are presented on men's knowledge of women's health and on their own sexual behavior outside the context of marriage, on their perceptions of sexual morbidity and their attempts at treatment for specific conditions, and on their opinions concerning the social role of wives. Findings indicate that men know little about maternal morbidity or sexual morbidity conditions. Few husbands reported that they had had sexual experience outside of marriage and the majority of these few said they had had such a relationship with more than one partner. Of men who said they had had reproductive morbidity symptoms, many said they had not sought treatment. Men's views concerning the role of wives indicate a low level of women's autonomy in this region of India. Results indicate a pressing need for reproductive health education that targets both women and men in Uttar Pradesh.     

Social history, mental health, and community control.

Develops 4 themes in discussing community control of mental health services: (a) the community mental health movement is considered from the viewpoint of social history; (b) the movement is discussed in terms of its underlying professional ideology; (c) some of the shifts which have taken place in the field that go beyond the traditional framework of mental health are considered; and (d) community control, one of the newer developments in the field, is discussed, and some of its unforeseen problems examined. (21 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Population, development, and reproductive behavior: Perspectives for population and health psychology.

Reviews global population trends, the interrelationship of population and development, and evolving public policies, especially in developing countries. How these trends relate to private reproductive behavior and to the professional responsibilities of population psychologists working within the broader context of health psychology and mental health and how they are concerned with individual, family, and community well-being and an improved quality of life are explored. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social control, health risk taking, and psychological distress among the elderly.

Most research on older adults' social networks has focused on the support-providing function of social relationships. Little gerontological research has addressed social control, or the role of social bonds in regulating deviant or risky behavior. Drawing on sociological theory, this study examined the hypothesis that social control discourages risky health practices while provoking psychological distress. Structured interviews conducted with 162 community-residing older adults assessed social control (direct attempts by others to influence participants' health practices and the existence of significant role obligations to others), health risk taking (medication misuse, alcohol consumption, cigarette smoking, and the overall level of unsound health practices), psychological functioning (depression, loneliness, and self-esteem), and interpersonal satisfaction (satisfaction with friends and family members). Analyses revealed little support for the hypothesis. Social control was only weakly related to participants' health practices and, contrary to expectation, was generally related to less psychological distress and to greater interpersonal satisfaction. Implications for social control theory and for further research are addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social health programs

During 1974--75, data on sex and family size were obtained from approximately 500 Brazilian college students and their parents. Sex ratios for the immediate and parental generations were 107:100 and 106:100, respectively. Correlation coefficients were calculated between sexes of various children in families of the immediate generation. A significant positive relationship was found between sexes of the first two children in families of two or more children. The overall correlation between sexes of successive births was positive but not significant. Correlation coefficients between sexes separated by one or more births were not significant. The observed frequencies of combinations of sexes within the various family sizes did not differ from expected frequencies. Average numbers of children per family were 4.39 and 6.80 for the immediate and parental generations, respectively. Average family sizes decreased as the formal educational level of the parents increased. If the parents' desired both sexes of children, such preferences had no measurable influence on family size.     

Sexually transmitted diseases and reproductive health in women

The effects of recombinant basic fibroblast growth factor (bFGF), insulin-like growth factor (IGF)-II and transforming growth factor (TGF)-beta 1 on dental pulp cells were investigated by light and transmission electron microscopy after their implantation for 1 and 3 weeks at central sites of mechanically exposed pulps in dog molar and canine teeth. The implants were Millipore filters that have been soaked with solutions containing 100 or 500 ng/ml of bFGF or IGF-II or 100 ng/ml of TGF-beta 1. Control filters were soaked with dog albumin. No changes in cell organization or matrix synthesis were seen after implantation of control filters. Groups of columnar, polarized cells with numerous mitochondria and Golgi elements or elongated cells unassociated with any matrix deposition were demonstrated after 1 or 3 weeks, respectively, in close proximity to the filters that had been soaked with bFGF solution; at a distance from these implants enhanced formation of an osteotypic matrix was seen beneath the exposure site. No particular response was found in close proximity to the filters that had been soaked with IGF-II solution after 1 or 3 weeks implantation but thick zones of osteodentine were found beneath the exposure site and at adjacent circumferential dentine sites. Numerous elongated, polarized cells with long cytoplasmic extensions invading the filter pores were consistently seen after 1 week in close proximity to the filters that had been soaked with TGF-beta 1 solution. After 3 weeks implantation of these filters, deposition of a tubular matrix surrounding the implants was seen in association with the highly elongated odontoblast-like cells, while enhancement of circumferential dentine formation was also found at adjacent peripheral sites. These experiments demonstrate that TGF-beta 1 when implanted for short term periods at central pulp sites exerted dentine-specific effects, inducing differentiation of odontoblast-like cells and stimulating primary odontoblasts. Implantation of bFGF and IGF-II did not result in reparative dentine formation, but did stimulate osteotypical matrix deposition at a distance from the implants.     

Video games in health care: Closing the gap.

Although a great deal of media attention has been given to the negative effects of playing video games, relatively less attention has been paid to the positive effects of engaging in this activity. Video games in health care provide ample examples of innovative ways to use existing commercial games for health improvement or surgical training. Tailor-made games help patients be more adherent to treatment regimens and train doctors how to manage patients in different clinical situations. In this review, examples in the scientific literature of commercially available and tailor-made games used for education and training with patients and medical students and doctors are summarized. There is a history of using video games with patients from the early days of gaming in the 1980s, and this has evolved into a focus on making tailor-made games for different disease groups, which have been evaluated in scientific trials more recently. Commercial video games have been of interest regarding their impact on surgical skill. More recently, some basic computer games have been developed and evaluated that train doctors in clinical skills. The studies presented in this article represent a body of work outlining positive effects of playing video games in the area of health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reproduction, risk and reality: family planning and reproductive health in northern Vietnam

In collaboration with the National Committee for Population and Family Planning, a study was conducted in 1994 in two Vietnamese communes to provide community level information on women's reproductive health and behaviors. A survey of 504 rural and 523 urban women collected five-year histories of reproduction, contraception, abortion and symptoms of Reproductive Tract Infections (RTI). This analysis focuses on the relationships between women's individual characteristics, use of family planning and abortion, and reported RTI symptoms. The findings reveal that IUDs do not raise women's likelihood of experiencing RTI symptoms in either commune. A recent abortion, however, strongly increases women's likelihood of having RTI symptoms in the rural commune, while low-socioeconomic status is associated with RTI symptoms in the urban commune.     

Factor structure of the Social Interaction Anxiety Scale and the Social Phobia Scale

In the study of social anxiety, it is common to differentiate between social interaction versus performance anxiety. The Social Interaction Anxiety Scale was designed to assess social interaction anxiety, and the Social Phobia Scale to assess fear of scrutiny by others (Mattick and Clarke, 1989). In common use, these scales are typically administered together and treated as subscales of a larger measure. However, the joint factor structure of these instruments has never been examined; therefore, it is unclear whether or not the items on these scales actually represent distinct aspects of social anxiety. In the present study, a confirmatory factor analysis of the pooled items from the SIAS and SPS failed to adequately fit the data. An exploratory factor analysis yielded three factors: (1) interaction anxiety, (2) anxiety about being observed by others, and (3) fear that others will notice anxiety symptoms. However, hierarchical factor analysis suggested that these factors all load on a single higher-order factor, social anxiety. Relationships of the first-order factors to other measures of social and performance fear and avoidance are examined, and implications of our findings for the assessment of social phobia are discussed.