Access to infertility care in a low-resource setting: bridging the gap through resident and fellow education in a New York City public hospital.

PURPOSE: Improving access to care is an issue at the forefront of reproductive medicine. We sought to describe how one academic center, set in the background of a large and diverse metropolitan city, cares for patients with extremely limited access to reproductive specialists. METHODS: The NYU Reproductive Endocrinology and Infertility (REI) Fellowship program provides a "fellow-run clinic" within Manhattan's Bellevue Hospital Center, which is led by the REI fellows and supervised by the REI attendings of the NYU Langone Health system. A description of the history of the hospital as well as the logistics of the fertility clinic is provided as a logistical template for implementation. RESULTS: The fellow-run fertility clinic at Bellevue hospital is held on two half days per month seeing approximately 150 new patients per year. The fertility workup, counseling, surgery, as well as ovulation induction, and early pregnancy management are offered within the construct of the fellowship and residency at NYU. Barriers to care and ways to circumvent those barriers are discussed in detail. CONCLUSION: By utilizing the ambition and construct of the OB/GYN programs, we greatly improve care for an otherwise underserved patient population by offering an efficient and optimal infertility workup and treatment in a population that would otherwise be without care. We utilize the framework of graduate medical education to provide autonomy, experience, and mentorship to both residents and fellows in our programs in an effort to provide a solution to combating inequity in infertility care.

Sexual and reproductive health education: contrasting teachers', health partners' and former students' perspectives.

CONTEXT: National guidelines recommend that Canadian sexual and reproductive health (SRH) education promote access to SRH services and effectively target SRH information to adolescents prior to their leaving secondary school. Within the context of rapidly changing health technologies (HPV vaccine, contraception innovations), SRH education can be an essential health promotion strategy targeting Canada's youth. SRH education in publicly funded Catholic and secular ("public") secondary schools in the National Capital Region, Canada was evaluated to determine whether it meets the standards of health promotion. METHODS: SRH strategies were collected by semi-structured interviews with 44 SRH educators: 15 public school teachers, 15 Catholic school teachers and 14 referent health partners and 31 young adults. Interview transcripts were subjected to deductive content analysis using the Information, Motivation, Behavioural Skills (IMB) model. RESULTS: Student uptake of SRH classroom themes (reproductive anatomy, contraceptive/condom use and risk prevention) was fairly consistent with teacher self-report. Students were encouraged to abstain from sexual activity by both public and Catholic teachers. SRH skill-building activities included relationship scenarios and facilitated access to SRH services by teachers from both Catholic and public schools, however only public schools provided condom demonstrations. Students recommended a more sex-positive education as sex was presented as an inherently negative and risky activity. CONCLUSIONS: SRH education, framed by the IMB model and in the context of school-community health partnerships, is an effective tool for health promotion. Knowledge transfer of biomedical SRH information is effective; however improvements can be made in the promotion of SRH self-efficacy.

Gênero, saúde reprodutiva e vida cotidiana em uma experiência de pesquisa-ação com jovens da Maré, Rio de Janeiro / Survey and action on gender, reproductive health and daily life with youngsters in Maré, Rio de Janeiro

O artigo apresenta uma conceituação da pesquisa-ação que articula a pedagogia de Paulo Freire e a proposta reflexiva e prática do movimento de mulheres. Pretende contribuir para ampliar a compreensão dos problemas que afetam a juventude brasileira com base nas questões de vida e saúde vivenciadas por jovens rapazes e moças moradores de uma área favelada da cidade do Rio de Janeiro. Estas questões foram captadas por meio de um projeto de pesquisa-ação que aglutinou jovens em grupos de reflexão-ação que adotavam, como temas geradores, a identidade de gênero, a sexualidade e a saúde reprodutiva. Esses temas iam gradativamente se conectando a outras questões significativas que emergiram das dimensões socioculturais e políticas mais amplas que afetam a vida dos jovens, particularmente daqueles que vivem em contextos de pobreza, violência e exclusão de direitos. Buscou-se consolidar, conceitual e empiricamente, o enfoque que transversaliza gênero na classe social e o paradigma de conhecimento que legitima um novo sujeito de conhecimento engajado na ação transformadora.

This article presents a conceptualization of action research which articulates Paulo Freire's pedagogy with feminist methods of consciousness-raising. It aims to contribute to wider comprehension of the problems which affect Brazilian youth by presenting questions of daily life as they are experienced by young men and women who live in the Complexo da Maré, an extensive area of favelas in the city of Rio de Janeiro. These questions were identified through a process of action research which articulated young people in consciousness-raising groups that adopted the 'generating themes' of gender identity, sexuality and reproductive health. These themes were connected to other significant questions which gradually emerged from the wider sociocultural and political dimensions that affect the lives of young people, particularly those who live in contexts of poverty, violence and exclusion from basic rights. An attempt is made to conceptually and empirically consolidate an outlook that transversalizes gender in social class and a paradigm of knowledge that legitimates new subjects of knowledge who are engaged in transformative social action.

Este artículo presenta una conceptuación de la pesquisa-acción que articula la pedagogía de Paulo Freire y la propuesta reflexiva y práctica del movimiento de mujeres. Se propone contribuir para ampliar la comprensión de los problemas que afectan a la juventud brasileña a partir de cuestiones de vida y salud vivenciadas por jóvenes - chicos y chicas - que habitan en el Complejo de Maré, área de favelas de la ciudad de Rio de Janeiro. Estas cuestiones se captaron a través de un proyecto que reunió a jóvenes en grupos de reflexión-acción, adoptando como temas generadores la identidad de género, la sexualidad y la salud reproductiva; temas que se conectan gradualmente con otras cuestiones significativas que emergían de las dimensiones socio-culturales y políticas más amplias que afectan a la vida de los jóvenes, particularmente de los que viven en contextos de pobreza, violencia y exclusión de derechos. Se buscó consolidar, conceptual y empíricamente, el foco en la línea transversal del género en la clase social y el paradigma de conocimiento que legitima un nuevo sujeto de conocimiento comprometido con una acción transformadora.

Discarded human spermatozoa, eggs and embryos for personnel training and practice in assisted reproduction.

An ethical issue that has been largely overlooked is the use of discarded human gametes and embryos for personnel training in clinical assisted reproduction technology, e.g. intracytoplasmic sperm injection and preimplantation genetic diagnosis. Unlike experimental research for generating peer-reviewed journal publications and intellectual property, there is no similar paper trail or smoking gun if human gametes and embryos are utilized solely for personnel training without the patient's knowledge and consent. For many assisted reproduction laboratories in private practice that are not affiliated with research or academic institutions, there are often difficulties in procuring animal material for personnel training. In contrast, discarded human gametes and embryos are readily available and can be convenient for training inexperienced personnel in assisted reproduction techniques. Very often, only verbal consent is obtained from patients, without written documentation, and this situation can potentially lead to abuse. For example, fertility clinics and laboratories may conduct training courses and workshops for generating additional income and revenue; and there is a possibility of discarded human material being utilized for such profit-making ventures without patients' prior knowledge. Hence, it is the moral duty and obligation of international professional bodies to advocate and draft clearly defined regulatory guidelines and legislative framework for this purpose.

The social context of reproductive health in an Egyptian hamlet: a pilot study to identify female genital schistosomiasis.

This pilot study is the first to identify female genital schistosomiasis (FGS) in an Egyptian community setting. The year-long interdisciplinary study, in a small hamlet (ezba), combined clinical assessment with an in-depth study of the social context of reproductive health. Schistosoma haematobium ova were found in 16.7% of women in the study (21/126). Half of the women who agreed to a full gynecological examination (43 of 86) had evidence of reproductive morbidity due to schistosomiasis, either schistosome eggs in the cervix or sandy patches, tissue changes in the reproductive tract. Other reproductive tract morbidities included infections (vaginitis 40%, chronic cervicitis 75%, pelvic inflammation 9%) and prolapse (54%). FGS was associated with dysparunia, abnormal vaginal discharge, vaginal or cervical polyps, contact bleeding, vulval itching and chronic cervicitis. Community members recognized S. haematobium as a health problem, but did not believe that it affected reproductive health. Indeed, they had little awareness of reproductive health and the possible impact of reproductive morbity on women's arduous daily tasks. There was no discussion of any reproductive health issues (except infertility) between women or between spouses. The study identified a number of factors that would affect the identification and treatment of FGS, and reproductive health care in general; (1) the neglect of women's health: (2) misconceptions about reproductive health and family planning; and (3) limited access to, and use of formal health care. The paper ends with a brief discussion of the significance of our findings about FGS, strategies to increase awareness of FGS, and the need for future research.

Women's perceptions and practices regarding their rights to reproductive health.

ABSTRACT At the outpatient clinic of Ain Shams University Maternity Hospital, perceptions and practices of 1000 women regarding their reproductive health rights (reproductive rights) were evaluated. The majority had positive perceptions about their rights to reproductive health; however, 30% disagreed with prohibitions of discrimination against women, particularly prohibitions of female genital mutilation (FGM). A significant association was found between perceptions of sexual rights and demographic characteristics and between education and practices regarding early detection of cancer. No significant association was found between education and concepts of adolescent health education as a reproductive right. Programmes about women's reproductive rights that emphasize the issue of sexual health through religious education are recommended as one of the best strategies for the eradication of FGM.

The ability of a long-case assessment in one discipline to predict students' performances on long-case assessments in other disciplines.

PURPOSE: To determine whether medical students' performances in a long-case assessment in one of four disciplines (internal medicine, pediatrics, reproductive medicine, or surgery) could predict later performances in long-case assessments in the other disciplines. METHOD: In their fourth of five years at the University of Newcastle, at the end of 12-week rotations in internal medicine, pediatrics, surgery, and reproductive medicine, students undertake long-case assessments. Each long-case assessment involves a real patient and a vive voce examination, and each is scored by two assessors. The author reviewed these scores, which could range from 5 to 20, for the years 1992 to 1997. RESULTS: Over the six years, 391 students completed 1,564 cases. In 249 cases, the students scored better than 11 on their first long-case assessments; of those, 16 (6.5%) went on to fail one of the three subsequent assessments. Of the 142 students who scored 10 or less on their first assessments, 25 (17.6%) went on to fail one of the subsequent three, and 9 (6.3%) went on to fail two more assessments. Of the 24 students who scored 10 or less on the first two assessments, 9 (37.5%) went on to fail one of the next two. There were statistically significant correlations among scores in all disciplines. CONCLUSIONS: Performance in any one of the four disciplines was a good predictor of performance in any other discipline. Except for borderline students, one case was almost as good a predictor as three, and for borderline or weak students two cases were nearly as good as three.

A tu salud / To your health

Documento que propicia la comunicación entre la familia en asuntos de salud. Es una recopilación de los artículos que aparecían en el Semanario Gente que servirán a la población de guía y vademecum para resolver y prevenir los priblemas de salud, con consejos sirigidos a toda la familia.

Enfoque y experiencia en educación sexual del Centro de Medicina y Desarrollo Integral del Adolescente / Approach and experience in sexual education at Medical and Integral Development Center of Adolescence

Se relata brevemente los principales hechos en el desarrollo de la educación sexual en Chile desde 1970 hasta la actualidad (1966). Se describe la importancia de la legislación vigente del Ministerio de Educación, que apoya el desarrollo de programas de educación sexual del sector, de acuerdo con el enfoque de cada establecimiento escolar. Se discute el concepto de educación sexual y se hace las diferencias con los conceptos de enseñanza de biología de la reproducción o enseñanza de la sexología o de enseñanza de moral sexual. Se describe el desarrollo cultural de sus diferentes etapas: "cultura del silencio"; "cultura familiar exclusiva"; "delegación de los aspectos biológicos en la escuela"; "familia y escuela co-responsables" y finalmente "escuela , familia y comunidad como un todo cultural". Se relata la experiencia del Centro de Medicina y Desarrollo Integral del Adolescente en educación sexual respondiendo las preguntas: qué, quién o quiénes, dónde, cuándo, cómo y con qué se enseña. Se describe el esquema de coordinación entre el sector salud y el sector educación en educación sexual y servicios al adolescente en el sistema municipalizado de atención primaria

Bases de trabajo comunitario para la implementación de un modelo de salud reproductivo

Se presenta un marco conceptual sobre el cual se ha desarrollado el Programa de Salud Reproductiva del Departamento de Gineco-Obstetricia y la División de Salud Comunitaria de la Fundación Santafé de Bogotá. Una vez determinada el área de influencia se analizaron la oferta de servicios de salud y la demanda y necesidad de servicios por parte de la comunidad. De acuerdo a estos resultados se han venido desarrollando programas y actividades que la comunidad siente como prioritarias. Esto ha permitido obtener credibilidad en nuestra Institución por parte de la comunidad y asegurar la aceptación de las labores que el Programa de Salud Reproductiva va a adelentar. Así por ejemplo, lograr establecer la necesidad del control prenatal, diagnóstico precoz del cáncer o la aceptación de programas de planificación familiar, no serán acciones aisladas en la comunidad expuesta al rechazo o a la indiferencia sino que forman parte de una atención integral de la salud en que la misma comunidad ha participado en su planeación y ejecución