Involvement of first-time mothers with different levels of education in the decision-making for their delivery by a planned Caesarean section: women's satisfaction with information given by gynaecologists and midwives
Autor/in:
Kolip, Petra; Büchter, Roland
Quelle: Journal of Public Health, 17 (2009) 4, S 273-280
Inhalt: Aims: We investigated the involvement of first-time mothers, who had a planned Caesarean section, in the decision to have a Caesarean section, taking into account their different educational levels. Subjects and methods: A self-assessment questionnaire was sent in July 2005 to women who had undergone a Caesarean section in 2004. Participants were 2,685 members of a statutory health insurance fund who had given birth by Caesarean section (response rate: 48.0%). Included were primiparae with planned Caesarean section (n = 352). Results: The women in this cross-sectional study felt well informed about the procedure of a section but not its consequences. They used several sources of information and were most satisfied with the information provided by doctors and midwives. Of the women in this study 20% did not have a midwife. No major differences were observed between different educational levels. Conclusion: Although most women were satisfied with their decision, they felt that they did not receive enough information about the consequences of a Caesarean section. This information need could be met by a further involvement of midwives in maternity care.
Schlagwörter:Caesarean section; Shared decision-making; Information needs; Birth
Community stroke knowledge: a new information strategy using a joint project of the public health service and the hairdressers' guild of the Wesel district
Quelle: Journal of Public Health, 17 (2009) 6, S 371-376
Inhalt: Objectives: The public health programme “Healthy Lower Rhine…against Stroke” is aimed at improving the population’s knowledge about stroke and thus at reducing the prehospital phase in patients with suspected stroke. First evaluation results indicate that apart from providing information through the mass media, there is an urgent need to further develop the face-to-face communication approach. This has to be achieved by efficient but also effective means, given that financial and personnel resources are scarce. Study design: In cooperation with lögd Bielefeld, the Lower Health Authority of the Wesel District (health department) developed a postcard-sized quiz card containing exclusively correct answers on the issue of stroke, risk factors as well as symptom and action knowledge. For face-to-face communication, the hairdressers could be convinced to be included in the project. The hairdressers posed the corresponding questions and marked those answers of the clients that were identical with the quiz card answers with a cross. Answers not given by the clients were read out loud to them by the hairdressers, who were thus “styling up” the knowledge of their clients. To increase participation in the project, prizes were offered for the hairdressers with the most filled-in quiz cards as well as for three of the participating clients (drawing of prizes 1–3). More than 380 hairdressers in the Wesel district were sent a letter inviting them to participate as facilitators in this project, which is probably the first of its kind worldwide. Methods: The machine-readable quiz cards were collected and statistically evaluated including data regarding age and gender of the participants. Results were to be presented in the form of a descriptive statistic. Results: Thirty-three hairdressers from 12 cities and municipalities of the Wesel district participated in this joint action of the Wesel district Department of Health and the Wesel hairdressers’ guild, dealing with the monitoring and imparting of basic knowledge on the issue of stroke. Almost 2,000 clients were interviewed by the participating hairdressers, and knowledge gaps were closed by information read out to them. Discussion: This innovative approach of imparting knowledge can be regarded as the model of an effective and economical way of communicating health information to the broader public.
Schlagwörter:Stroke prevention; "Healthy Lower Rhine ... against Stroke"; Hairdressers imparting health information
Private individual ambulatory health care providers in Madhya Pradesh province, India
Autor/in:
Costa, Ayesha; Eriksson, Bo; Diwan, Vinod K.
Quelle: Journal of Public Health, 17 (2009) 4, S 235-241
Inhalt: Background: Ambulatory health care services are a major contributor to the large and inequitable health financing burdens (largely out-of-pocket) faced by households in India. The private sector has a virtual monopoly over ambulatory curative services in rural and urban India. Despite this, there is little knowledge about who these providers are, their numbers, distribution, and activities. Aim: This study describes the numbers, gender, distribution, and characteristics of private individual ambulatory care providers in Madhya Pradesh (60.4 million people), one of India’s largest provinces. It discusses the suitability of this provider mix to deal with maternal and child health, a major health priority in the province. Method: A survey enlisting all health care providers was conducted in the 52,117 villages and 394 towns of the province. Results: There were 14,046 private qualified physicians (12.5% women), 57,684 qualified paramedics (3.4% women), and 89,090 unqualified providers (10% women) providing ambulatory services in individual setups. In addition, 55,393 traditional birth attendants provided home-based intranatal care. The macro organization of these providers in this setting is presented. Given the high levels of maternal and child mortality in the province, excessive reliance is placed on less than competent providers as these present lower access barriers. Conclusion: Given the public health priorities in this province (maternal and child health), the provider mix is not optimally suited to the populations’ needs. There is a lack of competent qualified care required to deal with the major causes of morbidity and mortality, particularly in rural areas. Access to qualified women providers is low. The lack of a cadre of qualified midwives possibly contributes to some of the high maternal mortality observed in this province.
Schlagwörter:gender; Gender; Human resources; Maldistribution; Health services India
Predictors of work ability in occupations with psychological stress
Titelübersetzung:Vorhersage der Arbeitsfähigkeit in Berufen mit psychologischem Stress
Autor/in:
Seibt, Reingard; Spitzer, Silvia; Blank, Matthes; Scheuch, Klaus
Quelle: Journal of Public Health, 17 (2008) 1, S 9-18
Inhalt: Aim: This study aimed to detect health- and work-related predictors of poor and good work ability in teachers (TE) and office workers (OW). Method: Work ability and its influence factors were analyzed in 100 female TE and 60 female OW aged between 25 and 60 years. The work ability was evaluated with the work ability index questionnaire and the health status with the vitality measurement system®. In addition, cardiac risk factors, burnout risk, as well as the working demands and effort-reward ratio were taken into account. Predictors of work ability were analyzed by using a CHAID analysis. The number of complaints represents the best predictor to divide both occupational groups into subgroups with different work abilities (criterion variable). Results: Poor work ability is caused by many complaints and cardiovascular risk factors. By contrast, excellent work ability is associated with few complaints, the occupation “office workers,” a younger vital functional age, and the absence of burnout symptoms, which means in comparison with OW, TE have a 1.6 times higher risk for impaired work ability. Furthermore, the absence of burnout symptoms is a resource of TE, whereas OWs tend to have a younger vital functional age compared to their calendrical age. Although this analysis is able to explain 61.2% of the influence on impaired work ability, research for further causes must be undertaken. Conclusion: The results reflect the positive effect of a high educational level and a challenging job on the preservation of good work ability. Moreover, they draw the attention to the psychological and psychosocial strains of TE. TEs are exposed more frequently to feeling overstrained; this probably effects a higher retirement rate due to illness.
Changes in secondary pharmacological prevention of acute coronary syndromes and stroke after hospital discharge: a 6-month follow-up study of German primary care patients
Quelle: Journal of Public Health, 17 (2008) 1, S 3-7
Inhalt: Aim: This study examined modifications in secondary preventive medication between the time of hospital discharge (HD) and during a 6-month follow-up treatment of outpatients with acute coronary syndromes (ACS) and stroke. Subjects and methods: During a 6-month period, a health diary was completed on a weekly basis by 98 patients who were initially hospitalised with ACS and 29 patients with strokes in the Cologne area (Germany). Changes in medication between the time of HD and follow-up treatment (weeks 2, 12, and 24) were recorded. Results: On average, patients with ACS took six medications, whereas patients with stroke took five medications per day. ACS patients received beta-blockers (96%), lipid-lowering agents (80%), and angiotensin-converting enzyme (ACE) inhibitors (64%) at HD, and no changes in medication were made during follow-up treatment. However, there was a significant decrease in prescriptions of clopidogrel among ACS patients within 6 months, and about 13% of ACS patients did not receive an antiplatelet agent at any time. Stroke patients received beta-blockers (50%), lipid-lowering agents (67%), and antiplatelet agents, such as acetylsalicylic acid (57%) or clopidogrel (27%), at the time of HD, and no significant changes in medication were instituted during follow-up treatment. Conclusion: Treatment of ACS patients with the combination of acetylsalicylic acid and clopidogrel was insufficient, although it has been shown that this combination is highly effective in secondary prevention of ACS. Besides medical reasons, the cost-containment restrictions (“medication budget”) for German physicians might explain the observed failure of guideline-oriented medication. Furthermore, no changes in medications occurred regarding blood-pressure- and lipid-lowering agents.