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1.  The right to choose parenthood among HIV-infected women and men 
Journal of public health policy  2009;30(4):367-378.
As life expectancy for HIV-infected persons improves, studies in sub-Saharan Africa show that a considerable proportion of HIV-positive women and men desire to have children in the future. Integrating sexual and reproductive health care into HIV services has emphasized the right of women to make informed choices about their reproductive lives and the right of self-determination to reproduce, but this is often equated with avoidance of pregnancy. Here, we explore guidance and attention to safer conception for HIV-infected women and men and find this right lacking. Current sexual and reproductive health guidelines are not proactive in supporting HIV-positive people desiring children, and are particularly silent about the fertility needs of HIV-infected men and uninfected men in discordant partnerships. Public health policymakers and providers need to engage the HIV-infected and uninfected to determine both the demand and how best to address the need for safer conception services.
doi:10.1057/jphp.2009.35
PMCID: PMC2830745  PMID: 20029426
HIV infection; HIV-positive women and men; fertility; parenting; reproductive policy and services; contraception
2.  "I am nothing": experiences of loss among women suffering from severe birth injuries in Tanzania 
BMC Women's Health  2011;11:49.
Background
Despite the increased attention on maternal mortality during recent decades, which has resulted in maternal health being defined as a Millennium Development Goal (MDG), the disability and suffering from obstetric fistula remains a neglected issue in global health. Continuous leaking of urine and the physical, emotional and social suffering associated with it, has a profound impact on women's quality of life. This study seeks to explore the physical, cultural and psychological dimensions of living with obstetric fistula, and demonstrate how these experiences shape the identities of women affected by the condition.
Methods
A cross-sectional study with qualitative and quantitative components was used to explore the experiences of Tanzanian women living with obstetric fistula and those of their husbands. The study was conducted at the Comprehensive Community Based Rehabilitation Tanzania hospital in Dar es Salaam, Bugando Medical Centre in Mwanza, and Mpwapwa district, in Dodoma region. Conveniently selected samples of 16 women were interviewed, and 151 additional women responded to a questionnaire. In addition, 12 women affected by obstetric fistula and six husbands of these affected women participated in a focus group discussions. Data were analysed using content data analysis framework and statistical package for the social sciences (SPSS) version 15 for Microsoft windows.
Results
The study revealed a deep sense of loss. Loss of body control, loss of the social roles as women and wives, loss of integration in social life, and loss of dignity and self-worth were located at the core of these experiences.
Conclusion
The women living with obstetric fistula experience a deep sense of loss that had negative impact on their identity and quality of life. Acknowledging affected women's real-life experiences is important in order to understand the occurrence and management of obstetric fistula, as well as prospects after treatment. This knowledge will help to improve women's sense of self-worth and maintain their identity as women, wives, friends and community members. Educational programmes to empower women socially and economically and counselling of families of women living with obstetric fistula may help these women receive medical and social support that is necessary.
doi:10.1186/1472-6874-11-49
PMCID: PMC3228718  PMID: 22082132
3.  Women's physical health and well-being 
Public Health Reports  1987;102(4 Suppl):9-11.
A relatively small number of physical disorders are unique to women, are more prevalent or serious in women, or require special prevention or intervention strategies in women. Among the earliest of these to appear developmentally are precocious puberty, for which an effective treatment has recently been developed, and anorexia and bulimia, which are increasing in frequency among young women without effective treatment. Arthritis, diabetes, lupus erythematosus, gallstones, and osteoporosis are other diseases in this category.
Reproductive health concerns are a major focus of women's health. The hundred-fold reduction in maternal mortality related to pregnancy is one of the major public health achievements of this century. Despite effective contraceptives, over half the pregnancies in this country are unintended; thus, solving the related problems of infertility and unintended fertility are research priorities. Improving pregnancy outcome, particularly reducing the rate of prematurity, also needs increased attention.
Cancer is the leading cause of death in middle-aged women. Lung cancer has replaced breast cancer as the primary cause of cancer death among women due to the increase of cigarette smoking among women. Smoking contributes to numerous other causes of death and disability among women. Of all things women could do to improve their health, the most important would be to avoid smoking.
PMCID: PMC1478036  PMID: 19313208
4.  Preconception and Contraceptive Care for Women Living with HIV 
Women living with HIV have fertility desires and intentions that are similar to those of uninfected women, and with advances in treatment most women can realistically plan to have and raise children to adulthood. Although HIV may have adverse effects on fertility, recent studies suggest that antiretroviral therapy may increase or restore fertility. Data indicate the increasing numbers of women living with HIV who are becoming pregnant, and that many pregnancies are unintended and contraception is underutilized, reflecting an unmet need for preconception care (PCC). In addition to the PCC appropriate for all women of reproductive age, women living with HIV require comprehensive, specialized care that addresses their unique needs. The goals of PCC for women living with HIV are to prevent unintended pregnancy, optimize maternal health prior to pregnancy, improve maternal and fetal outcomes in pregnancy, prevent perinatal HIV transmission, and prevent HIV transmission to an HIV-uninfected sexual partner when trying to conceive. This paper discusses the rationale for preconception counseling and care in the setting of HIV and reviews current literature relevant to the content and considerations in providing PCC for women living with HIV, with a primary focus on well-resourced settings.
doi:10.1155/2012/604183
PMCID: PMC3477542  PMID: 23097595
5.  Rehabilitation After Stroke 
Canadian Family Physician  1970;16(12):47-56.
The more severely involved the stroke patient is or the greater is the pre-existing physical disability, the greater is the need for special rehabilitation services to restore him to his optimal level of performance. The availability of resources in the family and community are important factors in determining whether or not the patient will need to be treated in a rehabilitation center. There is no contraindication to early initiation of rehabilitation and those patients for whom rehabilitation is initiated immediately after the stroke have the most rapid and optimal recovery. Ninety to 95 percent of hemiplegics can learn to walk. Forty percent of hemiplegics get good return of function in their upper extremity. Sixty-five percent of hemiplegics become independent in self-care and ambulation. For the stroke patient who does not have complicating disabilities independence in self-care and ambulation can be accomplished in 4 to 8 weeks. Intellectual or emotional problems indicate the need for a carefully planned rehabilitation program. The families of stroke patients need counseling and training regarding their responsibilities and duties to the patient.
Images
PMCID: PMC2281923  PMID: 20468595
6.  Breast cancer in the young: role of the geneticist 
Journal of Thoracic Disease  2013;5(Suppl 1):S19-S26.
The genetics professional plays an important role in the care of young women with breast cancer by providing counseling on issues specific to these young women. The issues addressed in counseling include hereditary predisposition to cancer, fertility and reproductive options in the context of hereditary cancer, and the impact and implications of their history of early breast cancer on close family members.
A thorough risk assessment and counseling session address the patient’s personal and family history, with particular attention paid to benign and malignant findings that suggest the need for genetic testing. Genetics professionals, especially genetic counselors, also address the physical and emotional implications of an increased risk of cancer with patients and family members. This review highlights the unique aspects of care provided by these specialized healthcare providers.
doi:10.3978/j.issn.2072-1439.2013.04.13
PMCID: PMC3695544  PMID: 23819023
Breast cancer; genetic counseling; risk assessment
7.  Chronic Medical Conditions and the Sex-based Disparity in Disability: The Cardiovascular Health Study 
Background.
Older women experience disability more commonly than their male peers. This disparity may be due, in part, to sex-based differences in the prevalence or the disabling effects of common medical conditions. The objectives of this analysis were to (a) quantify the extent to which excess disability in women is explained by higher prevalence of selected medical conditions and (b) evaluate whether the same conditions have differing effects on disability in men and women.
Methods.
We analyzed cross-sectional data from 5,888 community-dwelling older men and women. Disability was defined as difficulty with greater than or equal to one activity of daily living. Thirteen medical conditions were assessed by self-report, testing, or record review.
Results.
Controlling for age, race, education, and marital status, women were more likely to experience disability (odds ratio = 1.70, 95% confidence interval = 1.36–2.11). Higher prevalence of arthritis and obesity in women explained 30.2% and 12.9%, respectively, of the sex-based difference in disability rates, whereas male prevalent diseases like vascular conditions and emphysema narrowed the disability gap. Women with arthritis, hearing problems, coronary artery disease, congestive heart failure, stroke, and claudication were more likely to exhibit disability compared with men with the same conditions (p < .001).
Conclusions.
Efforts to lessen sex-based inequality in disability should focus on reducing the prevalence of arthritis and obesity. Future generations may see greater functional disparity if rates of vascular disease and emphysema rise among women. Several conditions were more often associated with disability in women, suggesting additional sex-based differences in the disablement process.
doi:10.1093/gerona/glq139
PMCID: PMC2990264  PMID: 20675619
Comorbidity; Disability; Gender; Function; Disparity
8.  The prevalence of exposure to domestic violence and the factors associated with co-occurrence of psychological and physical violence exposure: a sample from primary care patients 
BMC Public Health  2011;11:621.
Background
Since many health problems are associated with abuse and neglect at all ages, domestic violence victims may be considered as a group of primary care patients in need of special attention.
Methods
The aim of this multi-centre study was to assess the prevalence of domestic violence in primary care patients, and to identify those factors which influence the co-occurrence of psychological and physical violence exposure and their consequences (physical, sexual and reproductive and psychological) as obtained from medical records.
A study was carried out in 28 family practices in Slovenia in 2009. Twenty-eight family physicians approached every fifth family practice attendee, regardless of gender, to be interviewed about their exposure to domestic violence and asked to specify the perpetrator and the frequency. Out of 840 patients asked, 829 individuals, 61.0% women (n = 506) and 39.0% men (n = 323) were assessed (98.7% response rate). They represented a randomised sample of general practice attendees, aged 18 years and above, who had visited their physician for health problems and who were given a physical examination. Visits for administrative purposes were excluded.
Multivariate binary logistic regression analysis was used to determine the factors associated with exposure to both psychological and physical violence.
Results
Of 829 patients, 15.3% reported some type of domestic violence experienced during the previous five years; 5.9% reported physical and 9.4% psychological violence; of these 19.2% of men and 80.8% of women had been exposed to psychological violence, while 22.4% of men and 77.6% of women had been exposed to physical violence. The domestic violence victims were mostly women (p < 0.001) aged up to 35 years (p = 0.001). Exposure to psychological violence was more prevalent than exposure to physical violence. Of the women, 20.0% were exposed to either type of violence, compared to 8.0% of male participants, who reported they were rarely exposed to physical violence, while women reported often or constant exposure to physical violence. Their partners were mostly the perpetrators of domestic violence towards women, while amongst men the perpetrators were mostly other family members.
In univariate analysis female gender was shown to be a risk factor for domestic violence exposure. Regression modelling, explaining 40% of the variance, extracted two factors associated with psychological and physical violence exposure: the abuse of alcohol in the patient (OR 4.7; 95% CI 1.54-14.45) and their unemployment (OR 13.3; 95% CI 1.53-116.45).
Conclusions
As far as the study design permits, the identified factors associated with both psychological and physical violence exposure could serve as determinants to raise family physicians' awareness when exploring the prevalence of domestic violence. The results of previous research, showing at least 15% prevalence of exposure to domestic violence among primary care patients in Slovenia, and the female gender as a risk factor, were confirmed.
doi:10.1186/1471-2458-11-621
PMCID: PMC3160996  PMID: 21816070
Domestic violence; Physical Violence; Psychological Violence; Violence Prevalence; Risk Factors; Primary Care
9.  Urinary incontinence in older people in the community: a neglected problem? 
BACKGROUND: The prevalence and impact of urinary incontinence has been investigated much less in older men than in older women. It is suggested that those who perceive that their daily lives are affected should have priority for services. However, many people do not seek medical help, even though they may be severely affected. AIM: To investigate unmet need in relation to the prevalence and impact on everyday life of urinary incontinence in men and women over the age of 65 years. DESIGN OF STUDY: Cross-sectional survey to measure prevalence of urinary incontinence, the impact on people's lives, use of protection, and health services. SETTING: Stratified random sample of 2000 community-living elderly (equal numbers of men and women, aged 65 to 74 years and over 75 years) in 11 general practices in a British city. RESULTS: The response rate was 79%. The overall prevalence of incontinence in the previous month was 31% for women and 23% for men. Women generally had more severe frequency of incontinence and a greater degree of wetness than men. Protection use was greater in women than in men. Only 40% of men and 45% of women with incontinence had accessed health services. Significant predictors of the use of health services were: incontinence reported as a problem, increased frequency of incontinence, and greater degree of wetness. About one-third of people who leaked with severe frequency or who reported that it was a problem had not accessed NHS services for incontinence. CONCLUSIONS: Urinary incontinence is a common problem for older men and women living in the community and can have a deleterious effect on their lives. There is the opportunity to improve the lives of many older people with urinary incontinence, probably by a combination of increased public, patient, and professional awareness that should lead to earlier presentation and initiation of effective care.
PMCID: PMC1314046  PMID: 11462314
10.  Hypertension in women: latest findings and clinical implications 
Cardiovascular disease claims more women’s lives than any other disease. Hypertension is an important risk factor for cardiovascular disease in women but is often underestimated and undiagnosed and there is an ongoing misperception that women are at a lower risk of cardiovascular disease than men. The attainment of clinical blood pressure goals can markedly reduce cardiovascular morbidity and mortality, yet approximately two-thirds of treated hypertensive women have uncontrolled blood pressure. Furthermore, there are special risk factors that are unique for women that needs acknowledgement in order to help prevent the great number of hypertension-related events in women. Guidelines for treatment of hypertension are similar for men and women. More studies on the interaction between gender and response to antihypertensive drugs would be of interest.
doi:10.1177/2040622312438935
PMCID: PMC3513905  PMID: 23251774
cardiovascular disease; hypertension; women
11.  Morbidity Experiences and Disability Among Canadian Women 
BMC Women's Health  2004;4(Suppl 1):S10.
Health Issue
Women are more frequently affected by chronic conditions and disability than men. Although some of these sex differences have been in part attributed to biological susceptibility, social determinants of health and other factors, these gaps have not been fully explained in the current literature. This chapter presents comparisons of hospitalization rates, and the prevalence of chronic conditions and physical disability between Canadian women and men and between various subgroups of women, adjusting for selected risk factors. The Canadian Hospital Morbidity Database (2000–2001) and Canadian Community Health Survey (2000–2001) were used to examine inpatient hospital morbidity, prevalence of chronic conditions and disability.
Key Findings
Hospitalization rates were 20% higher among women than men. This was due to the large number of hospitalizations for pregnancies and childbirth. When "normal" deliveries were excluded, hospitalization rates remained higher among women. Women had slightly lower rates of hospitalizations for ambulatory-care sensitive conditions than men. Prevalence of activity limitation (mild and severe) was higher among women than men, and differences remained after adjusting for age, chronic conditions, socio-economic status, and smoking. Women who reported a disability were less likely than men to be in a partnered relationship, have less tangible social support, and have lower income and employment rates.
Data Gaps and Recommendations
The impact of morbidity and disability on Canadian women is substantial. These results identify areas for interventions among more vulnerable subgroups, and point to the need for further research in the area of risk factors for the prevention of morbidity and disability in the population.
doi:10.1186/1472-6874-4-S1-S10
PMCID: PMC2096699  PMID: 15345073
12.  Sexual Health 
BMC Women's Health  2004;4(Suppl 1):S24.
Health Issue
Much attention is devoted to women's reproductive health, but the formative and mature stages of women's sexual lives are often overlooked. We have analyzed cross-sectional data from the Sexual Behaviour module of the 2000/2001 Canadian Community Health Survey (CCHS), and reviewed the literature and available indicators of the sexual health of Canadian women.
Key Findings
Contemporary Canadian adolescents are becoming sexually active at younger ages than in previous generations. The gender gap between young males and females in age at first intercourse has virtually disappeared. The mean age at first intercourse for CCHS respondents aged 15–24 years was between 16 and 17. Canadian-born respondents are significantly younger at first intercourse than those who were born outside of Canada. Few adolescents recognize important risks to their sexual health. Older Canadians are sexually active, and continue to find emotional and physical satisfaction in their sexual relationships.
Data Gaps and Recommendations
Both health surveys and targeted research must employ a broader understanding of sexuality to measure changes in and determinants of the sexual health of Canadians. There is reluctance to direct questions about sexual issues to younger Canadians, even though increased knowledge of sexual health topics is associated with delayed onset of sexual intercourse. Among adults, sex-positive resources are needed to address aspects of aging, rather than medicalizing age-related sexual dysfunction. Age and gender-appropriate sexual health care, education, and knowledge are important not only for women of reproductive age, but for Canadians at all stages of life.
doi:10.1186/1472-6874-4-S1-S24
PMCID: PMC2096696  PMID: 15345087
13.  “…And Then There was the Down Low”: Introduction to Black and Latino Male Bisexualities 
Archives of sexual behavior  2008;37(5):675-682.
Although a recent proliferation of mass media has drawn attention to “the new Down Low phenomenon” (presumably “secretive” homosexuality among married Black men), relatively little research has explored bisexual behavior and identity among ethnic minority men in the United States or elsewhere. Although the study of bisexuality in Black and Latino men is significant in its own right, disproportionate rates of HIV/AIDS among these men make the current dearth of scientific information even more urgent and concerning. In this special section, we have compiled a diverse array of empirical and theoretical perspectives on Black and Latino male bisexualities. A wide range of information on the individual, social, and sexual lives of these men, and potential relations to risk behavior, are presented. This article introduces this new body of work and offers suggestions for future research directions for culturally appropriate interventions for Black and Latino bisexual men.
doi:10.1007/s10508-008-9359-4
PMCID: PMC2597583  PMID: 18506614
Bisexuality; Black; Latino; Men; Down low; HIV/AIDS
14.  Sex inequalities in access to care for patients with diabetes in primary care: questionnaire survey 
Background
Health experiences differ between men and women. The health services have focused their attention on gynaecological health problems in women, however women with non-gynaecological health problems could be unintentionally neglected. Given the increased prevalence of diabetes, the healthcare needs and experiences of women with diabetes are increasing.
Aim
To determine the extent of sex inequalities in access to care for diabetes in primary care.
Design of study
Cross-sectional population-based questionnaire study.
Setting
Twenty-three general practices spread through 23 different primary care trusts in the former Trent Region, UK.
Method
The study consisted of a random sample of 1673 patients with diabetes. Outcomes measured were odds ratios adjusted for age for measures of physical access to the GP's surgery; ease of obtaining appointments; access to primary care professionals; levels of routine diabetes care received; barriers to physical activity, problems eating and psychological distress as measured by the 18 score Diabetes Health Profile.
Results
Women were less likely than men to report that they had talked to their GP or practice nurse about their diabetes in the previous 12 months and were less likely to report that they were able to book routine appointments at convenient times. Almost 40% of all patients with diabetes reported difficulty in visiting the GP's surgery for their diabetes care, and women were more likely to report difficulties in visiting the surgery than men. Women were more likely than men to be afraid to go out alone (7.9% versus 3.6%) and more likely to be housebound (6.8% versus 2.4%). Women had significantly higher scores for eating problems and barriers to physical activity than men.
Conclusions
Women report more problems with access to diabetes care than men. If the ambitions of the National Service Framework are to be met, then positive action needs to be taken to improve access to care for women with diabetes.
PMCID: PMC1837842  PMID: 16638249
diabetes mellitus; health care quality, access, and evaluation; inqualities; sex
15.  JNER: a forum to discuss how neuroscience and biomedical engineering are reshaping physical medicine & rehabilitation 
Advances in neuroscience and biomedical engineering deeply affect the clinical practice of physical medicine & rehabilitation. New research findings and engineering tools are continuously made available that have the potential of dramatically enhancing the ability of clinicians to design effective rehabilitation interventions. This quickly evolving research field is difficult to track because related literature appears in a wide range of scientific journals. There is a need for a scientific journal that offers to its readership a forum at the intersection of neuroscience, biomedical engineering, and physical medicine & rehabilitation. The Journal of NeuroEngineering and Rehabilitation (JNER) is intended to fill this gap and foster cross-fertilizations among these disciplines. By making readily available to clinicians selected studies with potential impact on physical medicine & rehabilitation, JNER is anticipated to foster the development of novel and more effective rehabilitation strategies. Conversely, by presenting clinical problems to a readership of neuroscientists and engineers, JNER is expected to generate innovative work in neuroscience and biomedical engineering with future applications to physical medicine & rehabilitation. JNER will leverage on Open Access as a means to guarantee that its content is readily available to scientists, clinicians, and the general public thus promoting scientific and technological advances that are relevant to rehabilitation. JNER is an Open Access initiative. Open Access assures dissemination to the widest possible audience and is seen by many as essential for publicly funded research. BioMed Central offers an outstanding platform to make JNER possible and allow neuroscientists, biomedical engineers, and clinicians to see their work published in a timely manner and thus make an immediate impact in the field of rehabilitation. JNER will focus on innovative work with higher likelihood of a dramatic impact on rehabilitation. Thus, priority will be given to outstanding and visionary scientific reports, i.e. those proposing exceptionally innovative concepts with great potential in the field.
doi:10.1186/1743-0003-1-1
PMCID: PMC544948  PMID: 15679915
16.  Reorienting women's health in low- and middle-income countries: the case of depression and Type 2 diabetes 
Global Health Action  2014;7:10.3402/gha.v7.22803.
Women's health in low- and middle-income countries (LMICs) has historically focused on sexual and reproductive health. However, understanding how women acquire, experience, and treat non-reproductive health conditions, such as non-communicable diseases, has become a fundamental public health concern. Special attention to the social determinants of LMIC women's health can provide socially and culturally relevant knowledge for implementation of policies and programs for women increasingly confronting these ‘New Challenge Diseases’. This article uses the example of depression and Type 2 diabetes comorbidity to illustrate how attending to the social determinants of mental and physical health beyond the reproductive years contributes to a more holistic agenda for women's health. For instance, we must address the plurality of experiences that shape women's health from social determinants of depression, such as gendered subjugation within the home and public sphere, to the structural determinants of obesity and diabetes, such as poor access to healthy foods and health care. Attending to the complexities of health and social well-being beyond the reproductive years helps the women's global health agenda capture the full spectrum of health concerns, particularly the chronic and non-communicable conditions that emerge as life expectancy increases.
doi:10.3402/gha.v7.22803
PMCID: PMC3888885  PMID: 24433943
women's health; depression; Type 2 diabetes; life course; social determinants; epidemiological transition
17.  Women's health: time for a redefinition. 
Traditionally, women's health has been defined in mainly biologic terms. The various contexts within which women's health can be considered have been ignored, and many people have been unable to recognize the need for such a clinical entity as "women's health" in the first place. It is time for a change in attitudes and approaches. We need a more inclusive definition of women's health, one that takes into account social, cultural, spiritual, emotional and physical aspects of well-being. Case histories that have recently received media attention and statistics on the impact of poverty and violence on women also show how urgently a redefinition of "women's health" is needed. Regardless of whether "women's health" will always have to be viewed as a separate discipline or whether it can be brought within mainstream medical practice, it is clear that, by altering their perception of women's health and of the problems unique to women, physicians can improve both health care and medical education to the benefit of all members of our society.
PMCID: PMC1337701  PMID: 7859195
18.  Communal Living Settings for Adults Recovering from Substance Abuse 
Research on treatment outcome for addictive disorders indicates that a variety of interventions are effective. However, the progress clients make in treatment frequently is undermined by the lack of an alcohol and drug free living environment supporting sustained recovery. This introduction to a special edition on Oxford Houses suggests that treatment providers have not paid sufficient attention to the social environments where clients live after residential treatment or while attending outpatient programs. The paper begins with a description of the need for alcohol and drug free living environments. The history of communal living for recovering addicts and alcoholics is then reviewed and the Oxford House model emphasized as a recent and widespread communal living option for recovering persons. The structure and philosophy of Oxford Houses are presented along with recent outcome studies providing support for their effectiveness. Three different perspectives are presented as ways of conceptualizing how residents in Oxford Houses benefit: social context theory, self governance/self care, and peer affiliation/identification.
doi:10.1080/15560350802712355
PMCID: PMC2677754  PMID: 19424443
Oxford House; Sober Living House; Recovery Homes; Peer Helping
19.  Making a difference--women, medicine, and the twenty-first century. 
Women can and should make a difference in how medical care is given in the future. The increased number of women physicians presents an opportunity to make a significant impact on the quality of medical care. Data is provided on the number of women applicants to medical school, matriculants and graduates, specialty choices, the status of women in academic medicine, and the income of women physicians. Four aspects of the environment that portend important changes for medicine in the future are identified: scientific developments, alternative delivery systems and the corporate practice of medicine, the aging population and other demographic changes, and the expanding number of physicians. Some of these changes suggest opportunities for making a difference in the traditional specialties of medicine, in providing care to underserved populations, in research careers, in the shortage areas of preventive medicine and public health, occupational medicine, child psychiatry, and physical medicine and rehabilitation, and in new areas such as community pediatrics, behavioral pediatrics, and adolescent medicine. There are many choices and many decisions to be made, and each individual can choose to make a difference.
PMCID: PMC2590102  PMID: 3604289
20.  Serum Micronutrient Concentrations and Decline in Physical Function Among Older Persons 
Context
Maintaining independence of older persons is a public health priority, and identifying the factors that contribute to decline in physical function is needed to prevent or postpone the disablement process. The potential deleterious effect of poor nutrition on decline in physical function in older persons is unclear.
Objective
To determine whether a low serum concentration of micronutrients is associated with subsequent decline in physical function among older men and women living in the community.
Design, Setting, and Participants
Longitudinal study of 698 community-living persons 65 years or older who were randomly selected from a population registry in Tuscany, Italy. Participants completed the baseline examination from November 1, 1998, through May 28, 2000, and the 3-year follow-up assessments from November 1, 2001, through March 30, 2003.
Main Outcome Measure
Decline in physical function was defined as a loss of at least 1 point in the Short Physical Performance Battery during the 3-year follow-up. Odds ratios (ORs) were calculated for the lowest quartile of each nutrient using the other 3 quartiles combined as the reference group. Two additional and complementary analytical approaches were used to confirm the validity of the results.
Results
The mean decline in the Short Physical Performance Battery score was 1.1 point. In a logistic regression analysis that was adjusted for potential confounders, only a low concentration of vitamin E (<1.1 μg/mL [<24.9 μmol/L]) was significantly associated with subsequent decline in physical function (OR, 1.62; 95% confidence interval, 1.11-2.36; P=.01 for association of lowest α-tocopherol quartile with at least a 1-point decline in physical function). In a general linear model, the concentration of vitamin E at baseline, when analyzed as a continuous measure, was significantly associated with the Short Physical Performance Battery score at follow-up after adjustment for potential confounders and Short Physical Performance Battery score at baseline (β=.023; P=.01). In a classification and regression tree analysis, age older than 81 years and vitamin E (in participants aged 70-80 years) were identified as the strongest determinants of decline in physical function (physical decline in 84% and 60%, respectively; misclassification error rate, 0.33).
Conclusions
These results provide empirical evidence that a low serum concentration of vitamin E is associated with subsequent decline in physical function among community-living older adults. Clinical trials may be warranted to determine whether an optimal concentration of vitamin E reduces functional decline and the onset of disability in older persons.
doi:10.1001/jama.299.3.308
PMCID: PMC2645790  PMID: 18212315
21.  Periconceptional Folate Deficiency and Implications in Neural Tube Defects 
Journal of Pregnancy  2012;2012:295083.
Nutritional deficiencies are preventable etiological and epigenetic factors causing congenital abnormalities, first cause of infant mortality. Folate deficiency has a well-established teratogenic effect, leading to an increasing risk of neural tube defects. This paper highlights the most recent medical literature about folate deficiency, be it maternal or paternal. It then focuses on associated deficiencies as nutritional deficiencies are multiple and interrelated. Observational and interventional studies have all been consistent with a 50–70% protective effect of adequate women consumption of folates on neural tube defects. Since strategies to modify women's dietary habits and vitamin use have achieved little progress, scientific as well as political effort is mandatory in order to implement global preventive public health strategies aimed at improving the alimentation of women in reproductive age, especially folic acid supplementation. Even with the recent breakthrough of fetal surgery for myelomeningocele, the emphasis should still be on prevention as the best practice rather than treatment of neural tube defects.
doi:10.1155/2012/295083
PMCID: PMC3415073  PMID: 22900183
22.  A NON-COMPARATIVE DESCRIPTIVE STUDY OF THE RISK FACTORS FOR CHILDHOOD DISABILITY, AND THE REHABILITATION SERVICES IN JEDDAH, SAUDI ARABIA 
Objectives:
Identify the possible risk factors in our community that may influence having a disabled child, and identify the rehabilitation services available to disabled children.
Methods:
Data were collected from six rehabilitation institutes for auditory, visual and mental disabilities in Jeddah City during April 1999. Complete data available on sociodemographic and medical risk factors were extracted from the institutes’ files. Personal interviews with the disabled were conducted to confirm information on the services offered to them.
Results:
Certain modifiable risk factors affecting child health, such as early and late marriages and childbearing, illiteracy, unemployment, high parity and consanguineous marriages still exist in our community. Occupational hazards were also detected among military workers and working women. Disabilities related to perinatal health with antenatal, natal and postnatal components were also observed. According to resources available, various rehabilitation services are offered to disabled children.
Conclusion:
The need for intervention in two areas of health is crucial. The first is the prevention of future disabilities through continuous research, modification of unfavorable habits and the strengthening of the quality of perinatal care. The second is the improvement of rehabilitation services in order to raise the quality of life of the handicapped.
PMCID: PMC3437058  PMID: 23008642
Childhood disability; handicapped; risk factors; consanguineous marriage; perinatal care; Saudi Arabia
23.  Physical functioning in elderly Europeans: 10 year changes in the north and south: the HALE project 
Objectives: To examine age related changes in physical functioning in elderly men and women.
Design: Prospective, population based study.
Setting: Population of 15 rural and urban centres in 10 European countries.
Participants: Altogether 3496 men and women born between 1900 and 1920 who participated in the baseline survey of the HALE project in 1988–1991. The study population was examined again about five (in 1993–1995) and 10 (in 1999–2001) years after the baseline examination.
Main outcome measures: Physical functioning was measured by means of a self administered questionnaire of activities of daily living (ADL). Dichotomised prevalence of disability and need for help in self care and mobility ADL were used as dependent variables in the analyses.
Results: Prevalence of disability and need for help tended to be higher in women than in men and in mobility abilities than in self care activities. Disability and need for help increased with advancing age but ameliorated over time from one birth cohort to another. In longitudinal analyses this beneficial time trend was independent of the effect of age, study, and region in self care disability in men and women (OR 0.85, 95% CI 0.75 to 0.97 and OR 0.64, 95% CI 0.43 to 0.97, respectively) and self care need for help in men (OR 0.83, 95% CI 0.70 to 0.96). Mobility disability among men and self care disability among women decreased more in the south than in the north.
Conclusion: While European populations are aging, the proportions of elderly people with disability are decreasing. These results suggest that dynamics of functioning may differ across cultures. Future studies are needed to clarify which potentially modifiable and culturally determined factors protect against functional decline.
doi:10.1136/jech.2004.026302
PMCID: PMC1733089  PMID: 15831692
24.  Barriers to male involvement in contraceptive uptake and reproductive health services: a qualitative study of men and women’s perceptions in two rural districts in Uganda 
Reproductive Health  2014;11:21.
Background
Spousal communication can improve family planning use and continuation. Yet, in countries with high fertility rates and unmet need, men have often been regarded as unsupportive of their partner’s use of family planning methods. This study examines men and women’s perceptions regarding obstacles to men’s support and uptake of modern contraceptives.
Methods
A qualitative study using 18 focus group discussions (FGDs) with purposively selected men aged 15–54 and women aged 15–49 as well as eight key informant interviews (KIIs) with government and community leaders was conducted in 2012 in Bugiri and Mpigi Districts, Uganda. Open-ended question guides were used to explore men and women’s perceptions regarding barriers to men’s involvement in reproductive health. All FGDs and KIIs were recorded, translated, and transcribed verbatim. Transcripts were coded and analyzed thematically using ATLAS.ti.
Results
Five themes were identified as rationale for men’s limited involvement: (i) perceived side effects of female contraceptive methods which disrupt sexual activity, (ii) limited choices of available male contraceptives, including fear and concerns relating to vasectomy, (iii) perceptions that reproductive health was a woman’s domain due to gender norms and traditional family planning communication geared towards women, (iv) preference for large family sizes which are uninhibited by prolonged birth spacing; and (v) concerns that women’s use of contraceptives will lead to extramarital sexual relations. In general, knowledge of effective contraceptive methods was high. However, lack of time and overall limited awareness regarding the specific role of men in reproductive health was also thought to deter men’s meaningful involvement in issues related to fertility regulation.
Conclusion
Decision-making on contraceptive use is the shared responsibility of men and women. Effective development and implementation of male-involvement family planning initiatives should address barriers to men’s supportive participation in reproductive health, including addressing men's negative beliefs regarding contraceptive services.
doi:10.1186/1742-4755-11-21
PMCID: PMC3946591  PMID: 24597502
Male involvement; Contraception; Family planning; Reproductive health; Qualitative research; Uganda
25.  An interactive game-based shoulder wheel system for rehabilitation 
Background:
Increases in the aging population and in the number of accidents have resulted in more people suffering from physical impairments or disabilities. Rehabilitation therapy thus attracts greater attention as a means of helping patients recover and return to a normal life. With the extremely long and tedious nature of traditional rehabilitation, patients are reluctant to continue the entire process, thus the expected effects of the therapy cannot be obtained. Games are well known to help patients improve their concentration and shift their attention away from the discomfort of their injuries during rehabilitation. Thus, incorporating game technology into a rehabilitation program may be a promising approach.
Methods:
In this study, a gaming system used for shoulder rehabilitation was developed. The mechanical parts and electric circuits were integrated to mimic the functionalities of a shoulder wheel. Several games were also designed to suit the rehabilitation needs of the patients based on the age and gender differences among the individual users, enabling individuals to undergo the rehabilitation process by playing games. Two surveys were conducted to evaluate the satisfaction of the participants regarding the gaming system.
Results:
The results of the online survey among a larger population coincide with the responses of the hands-on participants through a paper-and-pencil survey. Statistical results suggest that the participants are willing to accept this novel approach.
Conclusion:
This gaming system can distract a patient from the sensation of pain or anxiety, and increase their motivation to participate in the therapeutic program. Advantages in terms of low-cost and easy setup increase the attractiveness of this new equipment for various potential users.
doi:10.2147/PPA.S37190
PMCID: PMC3514068  PMID: 23226005
virtual reality; virtual rehabilitation; shoulder wheel; game design

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