The treatment-seeking woman at menopause

Recent studies suggest that health care utilisation by women during menopause transition in general is highly idiosyncratic, despite the widespread advocation of prophylactic hormone therapy and increased health vigilance. The Melbourne Women's Midlife Health Study, a community-based cross-sectional study of 2001 urban Australian-born women aged 45-55 years, evaluated women's physical and emotional experiences, past and present health status, attitudes and beliefs about menopause, health behaviours and current menopausal status in a 30-min telephone interview. This paper reports on those factors related to help-seeking and health care utilisation. Findings show that treatment utilisers, in contrast to non-utilisers, reported a wider range of general symptoms, but reports on vasomotor symptoms did not contribute to the regression analysis. Treatment utilisers were further identified as problem-related or prevention-related utilisers. In three-way analyses, the past and present social and physical health of the problem-related treatment user was reportedly worse than either the prevention-related utiliser or non-utiliser. These findings suggest that medical and societal views about the health of middle-aged women during menopausal transition are likely to be based on the experiences of a particular segment of the population only. It is proposed that biased views of menopause as a time of considerable distress and ill-health are being perpetuated and over-generalised. This perspective appears to have little relevance for the majority of middle-aged women.

A study of the services provided by the women's health nurses in a Sydney Area Health Service

OBJECTIVES

To describe the client characteristics and nature of services provided by women's health nurses and to examine whether the goals set for the service are being met.

DESIGN

A retrospective study of women's health nurse (WHN) records from 1987 to 1991.

SETTING AND SUBJECTS

All women attending the women's health nurse in the Southern Sydney Area Health Service, 1987 to 1991. Older women and women of non English-speaking background are specific targets for this service.

OUTCOME MEASURES

Pap test and breast self-examination practices were examined in relation to age and ethnic background. Use of general practitioner services was examined for all women attending the women's health nurse in 1991.

RESULTS

Forty-five per cent of clients were aged over 50, and 29 per cent were from a non English-speaking background. Older women were more likely to return for subsequent visits to the women's health nurse. The practice of breast self-examination increased significantly between visits among all women. Forty-one per cent of women had not had a Pap test for at least three years, 93 per cent of these women were screened at their first visit. Eighty-seven per cent of women on their first visit and 86 per cent of women revisiting the women's health nurse had seen their general practitioner within the previous year.

CONCLUSION

Women's health nurses are meeting the goals set for their service in relation to health promotion and the screening of women. Their services are perceived by their clients as complementary to those provided by their general practitioners.

Preventive care for women. Does the sex of the physician matter?

BACKGROUND

Emphasis on ensuring women's access to preventive health services has increased over the past decade. Relatively little attention has been paid to whether the sex of the physician affects the rates of cancer screening among women. We examined differences between male and female physicians in the frequency of screening mammograms and Pap smears among women patients enrolled in a large Midwestern health plan.

METHODS

We identified claims for mammography and Pap tests submitted by primary care physicians for 97,962 women, 18 to 75 years of age, who were enrolled in the health plan in 1990. The sex of the physician was manually coded, and the physician's age was obtained from the state licensing board. After identifying a principal physician for each woman, we calculated the frequency of mammography and Pap smears for each physician, using the number of women in his or her practice during 1990 as the denominator. Using unconditional logistic regression, we also calculated the odds ratio of having a Pap smear or mammogram for women patients with female physicians as compared with those with male physicians, controlling for the physician's and the patient's age.

RESULTS

Crude rates for Pap smears and mammography were higher for the patients of female than male physicians in most age groups of physicians. The largest differences between female and male physicians were in the rates of Pap smears among the youngest physicians. For the subgroup of women enrolled in the health plan for a year who saw only one physician, after adjustment for the patient's age and the physician's age and specialty, the odds ratio for having a Pap smear was 1.99 (95 percent confidence interval, 1.72 to 2.30) for the patients of female physicians as compared with those of male physicians. For women 40 years old and older, the odds ratio for having a mammogram was 1.41 (95 percent confidence interval, 1.22 to 1.63). For both Pap smears and mammography, the differences between female and male physicians in screening rates were much more pronounced in internal medicine and family practice than in obstetrics and gynecology.

CONCLUSIONS

Women are more likely to undergo screening with Pap smears and mammograms if they see female rather than male physicians, particularly if the physician is an internist or family practitioner.

[A collaborative project of epidemiological research on the quality of care for the woman with a tumor. The Collaborative Research Group, the Barin Project]

The Barin Project aimed at evaluating the quality of health care for women affected by breast, ovarian and uterine cancer, using as a measure the satisfaction expressed by women. For 2 years women of the Associazione Coltivatori Diretti (a rural women association) accepted to report and describe a sample of contacts with health services, for any reason (symptoms, controls, exams) related, according to the women's perception, to cancer. 3,620 women participated in the survey: 2,313 (64%) completed questionnaires only 1,142 (50%) of them were of sufficient quality to be analysed. Data were compared with figures obtained in a previous survey on the same population and the following relevant changes were observed: the number of contacts with the general practitioner increased (27% vs 12%) and the number of women who underwent a screening almost doubled, with a sensible reduction of the delay due to the woman (2 vs 4 weeks of the previous survey). The number of episodes reporting an unfavourable evaluation of services and/or health personnel decreased from 41 to 3.8%.

Physical health problems and concerns of lesbians

Using a combined qualitative-quantitative methodology, a convenience sample of 503 women revealed that the most prevalent problems lesbian women encountered for which they did and did not seek traditional health care were menstrual, sexually transmitted diseases, reproductive, bladder or kidney, and breast problems. Reasons for not seeking health care were deduced, as was the manner in which the women participated in their health care, their feelings regarding health care, and how they would like to see health care changed.

FROGS (Far North Regional Obstetric and Gynaecological Service)--the development of a specialist outreach service

The Peninsula and Torres Strait Health Region of Far North Queensland is a vast area with a widely scattered population. The Far North Regional Obstetric and Gynaecological Service (FROGS) is a cost-effective outreach service which provides equitable access to specialist care for remote people and aims to address many of the significant problems of women's health care in this region.

A women-only clinic for HIV, genitourinary medicine and substance misuse

OBJECTIVE

To evaluate a multidisciplinary women-only clinic (WOC) providing HIV testing, HIV follow-up, genitourinary screening and a substance misuse service. The clinic is designed to attract women who are at risk of acquiring sexually transmitted infections, including HIV, yet are not using existing medical services.

DESIGN

A questionnaire survey and review of the case notes of women attending the WOC during the first seven months (April to October 1991) and comparison with a mixed-sex, daytime genitourinary clinic (John Hunter Clinic), and a HIV out-patients clinic (Kobler Centre) all within St Stephen's Clinic.

RESULTS

One hundred and twenty-nine women attended the WOC over the seven month period and 113 completed a questionnaire. The main reasons for attendance included a preference to be seen by a female doctor and staff, the presence of female patients in the waiting area, and the greater convenience of an evening clinic. In the absence of the WOC over half the patients (56%) indicated that they would not have attended a genitourinary medicine (GUM) clinic. The WOC attracted significantly more new patients than in the JHC (31.5% vs 15% p < 0.001). One hundred and four women (81%) were screened for genitourinary infection. Compared with the JHC there were significantly more cases of genital warts (33.9% vs 16.1% p < 0.001) and candidosis (41.5% vs 22.3% p < 0.001). A greater number of HIV tests were also performed (19% vs 9% p < 0.01). Sixteen (12.4%) women were HIV positive. Their attendance record at both first appointment (88% vs 64% p < 0.05) and subsequent follow-up appointments (81% vs 43% p < 0.05) was significantly higher than a comparable group of women seen by the same doctor (FB) in the Kobler Centre. The women also saw the health adviser more frequently. Although the number of injecting drug users was small (eight), all women currently injecting drugs entered a detoxification programme.

CONCLUSION

The WOC has become an established and popular service at St Stephen's. Women not previously using medical services are attending. The multidisciplinary nature of the clinic encourages a wider use of medical and paramedical services. Attendance record for HIV positive women has improved significantly. Whether these factors will lead to improved standards of sexual health will require a longer period of audit. Seventy-nine per cent of women indicated they would use a family planning service if available. An integrated family planning clinic was introduced after the audit period.

Female health care during Operation Desert Storm: the Eighth Evacuation Hospital experience

Little has been published concerning female soldiers' health care during combat. Therefore, a retrospective review of the Eighth Evacuation Hospital's gynecological records was performed while involved in Operation Desert Shield/Storm. Additionally, a health care survey was distributed to female soldiers. This review revealed that a large part of the hospital's gynecological resources during this conflict were employed treating preventable conditions. These problems could have been avoided if appropriate measures had been taken prior to deployment. It was concluded that all female soldiers should be required to undergo a gynecological health care screen prior to deployments.

Changing characteristics of Irish menopausal women seeking assistance

In the two years since its inception 425 patients have been seen at the Menopause Clinic. Audit of the first 100 women attending against 100 first seen one year later have revealed some significant differences in referral patterns. The earlier group were likely to have significantly more social problems whereas in the latter, more were likely to show concern for osteoporosis or need modification of ongoing treatment.

[Care for women: where and how]

OBJECTIVE

To analyse the demand for family planning, gynecological cancer tests and pregnancy supervision in an area with no public resources devoted specifically to these questions. To evaluate users' level of satisfaction and their readiness or otherwise to be visited at the Health Centre (HC), with a view to planning out a specific programme.

DESIGN

Descriptive study. SITE. Health Centre at Castelldefels. (Barcelona).

PATIENTS AND OTHER PARTICIPANTS

Random stratified sample of 595 women over 14, living within the centre's catchment area. The age distribution was selected in line with the town's population pyramid.

MAIN MEASUREMENTS AND RESULTS

We undertook a self-administered, anonymous survey of 437 women. 4.9% of those sexually active between the ages of 14 and 20 and 13.2% of women aged between 21 and 45 use no contraceptive method. The greater attendance at private rather than public centres for contraception (73% as against 23.8/1000 p less than 0.001) and for regular check-ups (63.8% as against 32.1/1000 p less than 0.001) was notable. But for pregnancy care it was the other way round (29.3% as against 61.2/1000 p less than 0.001). 64.1% have regular check-ups; 48.8% annually. A higher level of satisfaction is shown by women seen at private (95.2%) than at public centres (75.1/1000 p = 0.0159). 68.9% would use a special care services for women if offered by the HC.

CONCLUSIONS

Existing services offer scant cover to sections of the population more at risk and tend to make everything a medical problem. The public centres give little user-satisfaction. The Primary Care teams could cover these deficiencies with their services and would be welcome by the public.

Women's health: potential for better coordination of services

OBJECTIVE

To determine the proportion of women attending a genitourinary medicine clinic (GUMC) who are in need of contraception and the proportion of women attending a family planning clinic (FPC) who may require screening or treatment for sexually transmitted disease (STD).

DESIGN

Cross-sectional survey.

SETTING

A large FPC (17,600 attendances by women a year) and a large GUMC (20,060 attendances by women a year) in an inner London health district.

SUBJECTS

All clients attending the two clinics in consecutive weeks (356 GUMC and 335 FPC). In addition a non-random cluster of other women attending the same clinics later in the year were interviewed in depth (21 GUMC and 20 FPC).

RESULTS

Of women at the GUMC 10.4% (95% CI 7.2-13.6) were at risk of unwanted pregnancy and not using contraception. Women aged under 20 years and women not registered with a general practitioner (GP) were more likely to be in this group. A further 13.8% may have been using contraception unreliably as they were not obtaining contraception from a GP or FPC. Of women at the FPC 1.8% (95% CI 0.3-3.2) complained of symptoms of genitourinary infection. In-depth interviews showed that some women assumed the staff at both clinics would counsel them in all aspects of sexual health.

CONCLUSIONS

The opportunities presented at GUMCs to reduce the incidence of unwanted pregnancy and the opportunities presented at FPCs to reduce the incidence and prevalence of STD should not be missed.

Patterns of uptake and problems presented at Well Woman clinics in Liverpool

Well Woman clinics, at which all the staff are women, are provided on an open-access basis by Liverpool Health Authority. In 1986, uptake was low by women over the age of 55, by women from semi-skilled and unskilled manual households, and by women who did not have any formal employment. These, however, are the women who are at greatest risk of ill health. Almost half of the women attending had a vaginal problem or infection, and 40% were anxious or depressed. The clinics, however, are unable to treat any problems diagnosed, and over a third of women using the clinics were referred back to their general practitioner. The findings have important implications for the provision and continuity of primary and preventive care, not least because many women may be reluctant to take the problem which they present to Well Woman clinic doctors to their own (often male) general practitioner in a busy general surgery.

Older women's health and financial vulnerability: implications of the Medicare benefit structure

Elderly women and men have different patterns of disease and utilize health services differently. This essay examines the extent to which Medicare covers the specific conditions and services associated with women and men. Elderly women experience higher rates of poverty than elderly men; consequently, elderly women are especially likely to be unable to pay high out-of-pocket costs for health care. Using a new method for simulating out-of-pocket costs, the Illness Episode Approach, the essay shows that Medicare provides better coverage for illnesses which predominate among men than for those which predominate among women. In addition, women on Medicare who supplement their basic coverage by purchasing a typical private insurance "Medigap" policy do not receive as much of an advantage from their purchases as do men. The calculations also show that the Medicare Catastrophic Coverage Act would have had little impact on the gender gap in financial vulnerability.

Immunisation in a curative setting

OBJECTIVE

To study the uptake of vaccination offered to women and children attending a curative health facility.

DESIGN

Prospective survey over eight months of the uptake of vaccination offered to unimmunised women and children attending a diarrhoeal treatment centre as patients or attendants.

SETTING

The International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.

SUBJECTS

An estimated 19,349 unimmunised women aged 15 to 45 and 17,372 children attending the centre for treatment or accompanying patients between 1 January and 31 August 1989.

MAIN OUTCOME MEASURES

The number of women and children who were unimmunised or incompletely immunised was calculated and the percentage of this target population accepting vaccination was recorded.

RESULTS

7530 (84.2%) Of 8944 eligible children and 7730 (40.4%) of 19,138 eligible women were vaccinated. Of the children, 63.8% were boys, 75.9% were aged under 1 year, and 23.0% were aged 1 to 2 years. The estimated number of missed opportunities for vaccination was 716 among the children (8.0% of the target population) and 11,408 among the women (59.6% of those eligible).

CONCLUSION

It is possible to establish immunisation services at a health facility treating acutely ill patients.

[Knowledge and attitudes regarding family clinics on the part of women who use or do not use them]

Thanks to large civil participation and to the women's movement in 1975 a law has been approved that institutes family health clinics. This law is dedicated in particular to health and general services for women and to family planning. The Hygiene Department of University of Perugia has studied during this time: the family health clinics (FHC) activity in order to determine how well it is meeting the institutional aims. The knowledge and the attitudes of women with respect their use of FHC which have been projected onto the community. Health Education has a very important role because it is quite often basis for acceptance of FHC by women. The identification of all aspects of cultural resistance is very important. To this point a research project has been completed. The focal point of this research concerns women and their ability to profit from available information, as well as their attitudes and evaluation of the FCH. This study has been using a representative sample of Umbrian women, aged 16-50 ys old, at March 1987; the sampling method was of two stage. On the whole 1647 observations have been made by means of a mail questionnaire. The responders were very low (about 25%), so the results obtained must be considered with extreme caution. Generally there is a positive opinion on family health clinic: women are linked to a service of the community. They express satisfaction with the service. They express opinions on both positive and negative aspects. Even if the first approach is generally determined by a gynecological visit, the users redefine the service in a less ambulatory manner and into a more consultative one. In fact, users consider the FHC as a reference for women's problems. They underline the lack of sexual and health consulting service. There is demand for counseling for infancy problems, sterility, health education and sexual education. Even the non-users have a sufficiently clear idea of the family health clinics. Non-users view the FHC as a service for women's problems as well as relationship problems.

Medicaid: the lower tier of health care for women

Being poor in the United States means being exposed to the Medicaid system, whose characteristics, as determined by both federal and state policy, affect access to health care. This paper examines those aspects of the Medicaid system which have a disparate impact on women because they are overrepresented in certain social strata, as well as some aspects which affect the ability of both sexes to utilize the health care system. Owing to the problems of women in society, women make up two-thirds of the Medicaid clientele. Thus the burdens created by the limitations of Medicaid are a significant gender issue. Policies regarding AFDC coverage and pregnancy particularly concern younger women, many of whom have problems related to marriage, childbirth, and absence of economic support from fathers which place them at risk for poverty. Regulations as to income and assets of elderly persons requiring long-term care are among the policies that affect older women whose spouses have become disabled. Mandating less restrictive eligibility standards and coverage during transition of Medicaid clients to work would help address the twin problems of inferiority and uncertainty with regard to health care.

Women's health and women's work in health services: what statistics tell us

This article draws together statistical information in several broad areas that relate to women's health, women's reproductive activities and women's occupations in Sweden. The statistical analysis reflects the major changes that have occurred in Swedish society and that have had a major impact on the health and well-being, as well as on the social participation rate, of women. Much of the data is drawn from a recent special effort at Statistic Sweden aimed at influencing the classification, collection and presentation of statistical data in all fields in such a way that family, working, education, health and other conditions of women can be more readily and equitably compared with those of men. In addition, social changes have seen the shifting of the responsibility of health care from the unpaid duties of women in the home to health care institutions, where female employees predominate. These trends are also discussed.

Health care services and sterilization among Puerto Rican women

This paper considers the variables related to the type of health care utilization for sterilization and family planning among Puerto Rican women. The study is based on a representative sample of 1,375 women between the ages of 15-49 years. The data shows that the majority of women used the private sector of health care for their sterilization. Younger women, women with a low level of education, unemployed, living in consensual marriages and those who had their children as adolescents, made more use of the public services for their sterilization. It is a well proven fact that women with the above mentioned characteristics are more socioeconomically deprived than the educated, married and working women. Thus, it is to be expected that this group of women does not have the economic resources needed to utilize the private health care system.