Counseling adolescents with congenital heart disease

Adolescents with congenital heart disease need information regarding their cardiac condition and health care needs, including any life-style implications of the cardiac diagnosis. Pertinent topics to be addressed include preventive health care needs, physical activity (recreational and vocational considerations), pregnancy and contraception issues, and psychosocial stresses of adolescents. Sensitive counseling and health education by nurses can promote the physical health and psychosocial adaptation of adolescents with congenital heart disease.

Hey girlfriend: an evaluation of AIDS prevention among women in the sex industry

Increasingly, acquired immunodeficiency syndrome (AIDS) prevention programs have been developed to reach and influence street-based populations. Standard methods of evaluation do not fit the conditions of such programs. This article describes a process and outcome evaluation of an AIDS prevention program for sex workers in which qualitative and quantitative methods were combined in order to mediate research problems endemic to street-based populations. Methods included epidemiological questionnaires, open-ended interviews with participants, and ethnographic field notes. Process evaluation findings show that field staff who were indigenous to the neighborhood and population readily gained access to the community of sex workers and simultaneously became role models for positive behavior change. Outcome findings show that sex workers do feel at risk for AIDS, but usually from clients rather than from husbands or boyfriends. Accordingly, they use condoms more frequently with clients than with steady partners. Increasing condom use among sex workers with their steady partners remains an important challenge for AIDS prevention. Combining qualitative and quantitative research data provided a more comprehensive assessment of how to reach sex workers with effective AIDS risk reduction messages than either method could have provided alone.

Infant and child mortality in rural Egypt

This research examines determinants of infant and child mortality in rural Egypt, primarily the effects of household economic status and the availability of health services. Certain features of the health service environment affect survival in the neonatal period. In early childhood, survival chances improve markedly as income increases and if the household depends almost exclusively on employment income. In infancy and in early childhood, mortality is strongly associated with region of residence and maternal demographic characteristics, and is weakly associated with parental schooling.

A Community Health Education System to meet the health needs of Indo-Chinese women

This paper presents a Community Health Education System which is cost-effective, sustainable, strongly community-based, and directed at improving the health status of rural women in Indo-china (Kampuchea, Laos and Vietnam). The system is developed through a series of steps which are concerned with the education of Community Health Education Units (in national ministries of health) and, at the village level, among community health workers, women's groups, and other women. The ultimate aim is the establishment of a community health education program in Indochinese villages.

Postpartum IUDS: keys for success

Intrauterine device (IUD) insertion is convenient and efficient in the postplacental and immediate postpartum periods. Insertion at these times is demonstrably safe, having a low incidence of infection, few bleeding problems, and low perforation rates. IUD expulsion rates can vary widely, and are a function of timing of insertion, type of IUD, and insertion technique. When a copper T device is inserted postplacentally or immediately postpartum by an experienced and trained clinician, expulsion rates of about 7-15 per 100 users at six months can be expected. Women must be told how to detect expulsions and instructed to return for reinsertion or for another method. Most investigators emphasize that high fundal IUD placement will reduce the expulsion rate. Unplanned pregnancy rates for postplacental IUD insertion range from 2.0-2.8 per 100 users at 24 months when using modern copper IUDs, correct insertion technique, careful postinsertion instructions and good follow-up. Postplacental insertions are performed manually or with a ring forceps. Immediate postpartum insertions (10 minutes to 48 hours after delivery) are performed with the ring forceps.

The destination decision of political migrants: an economic approach

"This paper deals with the destination decision of political migrants who, in spite of having strong cultural, ideological and religious ties to a particular potential destination, choose to emigrate elsewhere. The model presented characterizes the migrants, who have a choice of two possible destinations, by two properties, skill level and financial resources, and identifies those that move to each destination. The paper examines various immigration-encouraging policies and shows that although all of them will increase immigration, in some cases the economic quality of the new immigrants will rise and in some it will fall. This paper includes general evidence on the present immigration to Israel and some suggestions for empirical tests."

Black males who always use condoms: their attitudes, knowledge about AIDS, and sexual behavior

One hundred six black males completed a questionnaire concerning attitudes and knowledge about the use of condoms and acquired immunodeficiency syndrome (AIDS). Of the 106 males in the study, 27 (26%) reported that they "always" used condoms, 31 (29%) did not use condoms and had low intentions of using them, and 48 (45%) reported high intentions to use condoms. Results indicated that knowledge about AIDS was exceptionally high for black males in all three groups. Black males with low intentions to use condoms reported significantly more negative attitudes about the use of condoms (eg, using condoms is disgusting) and reacted with more intense anger when their partners asked about previous sexual contacts, when a partner refused sex without a condom, or when they perceived condoms as interfering with foreplay and sexual pleasure. A significantly larger percentage of low intenders were treated for gonorrhea, syphilis, herpes, and genital warts than males in the other groups. Drug use did not differentiate the three groups, although marijuana was used more often by males in the low-intender group. Finally, a larger percentage of black males in the low-intender group reported experiences with anal intercourse and sex with a prostitute, but considered themselves at lower risk for AIDS than did their high-intender or steady-user counterparts.

Factors influencing early perinatal mortality in a rural district hospital

Early perinatal mortality (EPM) was prospectively analysed in a rural District Hospital during a 4 month period. 2,171 deliveries were recorded with an early perinatal mortality rate (EPMR) of 53/1000. Factors significantly influencing EPM included maternal age, education, marital and socio-economic status. Antenatal care, gestation at delivery, birthweight, pregnancy and labour complications were other significant factors. A maternal mortality rate of 2.8/1000 was also recorded. The study findings and possible lines of intervention are discussed.

An overview of artificial heart valve replacement in infants and children

Prosthetic heart valve replacement in infants and children poses unique problems. This article provides an overview of the factors specific to children with regard to indications and timing of valve replacement, types of artificial valves, constraints, and ramifications of valve choice in children. Anticoagulation, pregnancy, and other issues related to long-term management are reviewed.

Is AIDS education related to condom acquisition?

The acquisition and subsequent use of condoms are two important behaviors that sexually active adolescents must adopt to reduce the transmission of human immunodeficiency virus (HIV). The aims of this study were: first, to evaluate whether combining prescriptions for free condoms with anticipatory guidance would increase the number of adolescents actually using the prescription-redemption plan; and second, to see if education about acquired immunodeficiency syndrome (AIDS) might make adolescents more willing to obtain an HIV blood test. Adolescents were randomly assigned to one of three groups, but only those who were sexually active were included in the data analyses. Each participant was given a prescription to be redeemed for free condoms at the hospital pharmacy, and each was privately offered a confidential, free HIV blood test. Education about AIDS did not increase the likelihood that adolescents would take the blood test, since only seven subjects did so. Our logistic regression model showed the most significant variables influencing a teenager to obtain condoms were gender, socioeconomic status, lifetime number of partners, and experimental condition. Anticipatory guidance concerning HIV promoted the use of the prescription-redemption plan especially among more sexually active males who come from middle-class families.

Conception of AIDS and its prevention among students in a Nigerian university

This study examines AIDS awareness, knowledge of transmission and prevention among students, who not only belong to the sexually active age bracket, but who are the future leaders of the nation. The student population was stratified into those in the health and non-health disciplines and an accidental sampling technique was used to obtain the respondents from the 2 strata. 60 students were interviewed from each stratum. A majority of the medical students, 58.3% as against 48.3% of the non-medical students, perceived AIDS as a dreadful disease that is sexually transmitted. Next among the non-medical students were those who felt that AIDS was God's punishment for man's sexual excesses (20.0%), while only 3.3% of the medical students gave that response. Of importance in the study is that none of the students attributed AIDS to mystical forces, an issue which could be linked to their educational exposure. Some students associated the disease with affluence, an issue that had been documented by other researchers. Another point worthy of note in the study is the fact that even though 89% and 61.2% of the medical and non-medical students, respectively, believed that AIDS can be prevented by the use of condoms, most of them were not favourably disposed towards the use of condoms. This study thus reveals an area that needs attention, ie that apart from emphasising the level of awareness, there should be a focus on how to effect behavioural change among a knowledgeable population.