Trauma-informed care in general practice: Findings from a women's health centre evaluation.

BACKGROUND AND OBJECTIVES: Trauma and adversity have serious health consequences, particularly when experienced in early life. These health consequences can be significantly lessened if young people access appropriate care when needed. In 2004, the Blue Mountains Women's Health and Resource Centre created a Young Women's Clinic (YWC) that began providing drop-in appointments for women aged 12-25 years with a general practitioner, nurse or counsellor, as well as a group art program. METHOD: A qualitative evaluation of services provided by the YWC was conducted, drawing on 13 years of client and staff experiences. The evaluation framework was drawn from the recommendations of the NSW Centre for Advancement of Adolescent Health, the Australian Women's Health Network and the World Health Organization report on People-centred and integrated health services. RESULTS: The following principles of trauma-informed care were identified in the study: recognising the impact of trauma on consultations; tailoring consultation length to client needs; providing trauma therapy as well as physical healthcare; offering long-term, safe relationships with staff; trauma-sensitive gynaecological care; and the importance of self-care for health practitioners. DISCUSSION: Our findings demonstrate the importance of holistic general practice services in preventing and managing the long-term health consequences of adversity and trauma.

[The statement of Polish Society's Experts Group concerning diagnostics and methods of endometriosis treatment]. / Stanowisko Zespolu Ekspertów Polskiego Towarzystwa Ginekologicznego dotyczace diagnostyki i metod leczenia endometriozy.

Endometriosis is defined by endometrial glands and stroma outside of the endometrial cavity Three types of endometriosis have been described: peritoneal endometriosis, ovarian endometriosis and deep infiltrating endometriosis. Endometriosis afflicts 6-15% of women population. It occurs mainly in the group of women in reproductive age, but also in the group of minors and approximately 3% of women after menopause. Within the group of women suffering from infertility the frequency of endometriosis increased to 35-50% of cases. Endometriosis is associated with pain symptoms which can bear the character of pain occurring periodically and altering into constant pain, dysmenorrhea, dyspareunia, dysuria and dyschezia. The correlation between the stage of endometriosis and intensity of pain symptoms not always has to be proportionate. Laparoscopy can be perceived as a standard procedure in endometriosis diagnostics as it allows simultaneous treatment. Profound interview as well as visual diagnostics (USG, MRI) should precede laparoscopy Treatment of endometriosis can be divided into pharmacological and surgical treatment, which can be invasive or non-invasive. The type of treatment depends on patient's age and her procreation plans, occurring ailments and endometriosis type. Important role is played by adjuvant treatment such as appropriate diet and lifestyle. Treatment of advanced endometriosis should be conducted in reference centres that are appointed with adequate equipment and have the possibility of interdisciplinary treatment. Presented standards can digest and outline the order of proceedings both in diagnostics and endometriosis treatment. The research group believes that the above compilation will facilitate undertaking appropriate decision in diagnosis and treatment of the disease, which will subsequently contribute to therapeutic success.

Effect of an integrated support programme on the concerns and wellbeing of women with breast cancer: a national service evaluation.

PURPOSE: To carry out a national service evaluation of the integrated cancer support programme offered by The Haven using the Measure Yourself Concerns and Wellbeing (MYCaW) outcome questionnaire. METHODS: Breast cancer survivors who visited one of three Haven centres in the UK completed the MYCaW questionnaire before and after 6 one-hour complementary therapy sessions. RESULTS: Statistically significant decreases in mean baseline scores (indicating improvement) for concerns and wellbeing were observed after treatment: concern 1 (5.09 ± 1.04 vs 3.17 ± 1.60, p < 0.0001, n = 402), concern 2 (4.69 ± 1.08 vs 3.08 ± 1.56, p < 0.0001, n = 372), and wellbeing (3.30 ± 1.41 vs 2.63 ± 1.28, p < 0.0001, n = 402). The therapies most commonly used were acupuncture, nutrition, massage and aromatherapy, shiatsu, counselling and reflexology. After therapy, 91% of reported scores (n = 328) rated the concern as being a little better, much better or gone. CONCLUSIONS: These findings suggest that women with breast cancer find the Haven integrated support programme valuable for addressing their main concerns and improving their feeling of wellbeing.

Racial and ethnic approaches to community health: reducing health disparities by addressing social determinants of health.

Poor people and people of color are more likely to live shorter and sicker lives and are less likely to survive a host of chronic illnesses. Policies and organizational practices that improve the environments in which people live, work, learn, and play can reduce these disparities. Using the World Health Organization's "Call to Action" principles as a discussion framework, we highlight the Centers for Disease Control and Prevention's Racial and Ethnic Approaches to Community Health programs that have developed and applied such strategies to address chronic illnesses. Several, in turn, foster health equity.

Immigrant women's experiences of receiving care in a mobile health clinic.

AIM: This paper is a report of a study of the experiences of Portuguese-speaking immigrant women who used a mobile health clinic for their reproductive health care. BACKGROUND: Upon arrival in Canada, immigrant women often are in better health than their Canadian-born counterparts; however, this health status tends to deteriorate over time. One reason for this change is limited access to services. METHOD: Data collection during 2004 and 2005 involved individual interviews with seven Portuguese-speaking women who received care in a mobile health clinic in Toronto, Canada, and with four clinic care providers. Non-participant observation of the interaction between clients and care providers was also conducted. Interviews conducted in Portuguese were translated into English and transcribed, along with those conducted in English. Interview transcripts were read and re-read in the context of observational notes to develop codes. Emerging codes were grouped together to develop subcategories and categories. FINDINGS: Participants' experiences of accessing and receiving care in the mobile health clinic were shaped by their perceptions of health, which included physical, mental, social and spiritual aspects, and their pre- and postmigration care experiences. As an alternative model of care delivery, the mobile health clinic was perceived by participants to address their care needs and to help overcome postmigration barriers by providing accessible, holistic, and linguistically and culturally appropriate care. CONCLUSION: Mobile health clinics should be considered as an alternative care delivery model for immigrant women who may be at a disadvantage because of their socio-economic, cultural, and racialized statuses.

Mothers' health in Brazil and recovering the training of midwives for care in the birth process.

The authors briefly analyze the situation of maternal health care in Brazil and, based on their findings, they comment that there have been transformations in the health care model for women and families and propose some measures, including recovery of the work of the obstetric nurse or midwife (obstetriz, in Portuguese). They comment that women care tendencies in the delivery process presuppose incorporation of the paradigm of improving the physiology of valuing women's experience, the approach to the family, health advice that prioritizes prevention, education and relationships, without ignoring safety. They appoint that building this health care model, which includes the work of the midwife, may improve maternal health indicators.

[Health practices in the reorientation of primary care in Rio de Janeiro State, Brazil, from the perspective of users and health professionals]. / Práticas em saúde no contexto de reorientação da atenção primária no Estado do Rio de Janeiro, Brasil, na visão das usuárias e dos profissionais de saúde.

This evaluative study focused on expansion of the Family Health Strategy in large cities in Rio de Janeiro State, Brazil. The study analyzed the functionality of health care modalities, performance, and supply of comprehensive care itself and its link to services at other levels. The thrust of the analysis was comprehensiveness of care in the daily routine of health services, with a focus on childbearing-age women, and with pregnancy as the tracer condition. The results emerged from an analysis of focus groups with health care users and health professionals, based on: characterization of key actors; their perceptions concerning health, healthcare model, and organization of primary care services and practices. The groups suggested that the actors perceive health as identified with social determinants. Access to services and actions was differentiated in the family health unit by enrollment of the clientele and active search, and the study showed the lack of a structured network. The study indicates that work processes contemplating the social determination of health and its intersectorality can lead to expanded access to comprehensive care for childbearing-age women.

Práticas em saúde no contexto de reorientação da atenção primária no Estado do Rio de Janeiro, Brasil, na visão das usuárias e dos profissionais de saúde / Health practices in the reorientation of primary care in Rio de Janeiro State, Brazil, from the perspective of users and health professionals

This evaluative study focused on expansion of the Family Health Strategy in large cities in Rio de Janeiro State, Brazil. The study analyzed the functionality of health care modalities, performance, and supply of comprehensive care itself and its link to services at other levels. The thrust of the analysis was comprehensiveness of care in the daily routine of health services, with a focus on childbearing-age women, and with pregnancy as the tracer condition. The results emerged from an analysis of focus groups with health care users and health professionals, based on: characterization of key actors; their perceptions concerning health, healthcare model, and organization of primary care services and practices. The groups suggested that the actors perceive health as identified with social determinants. Access to services and actions was differentiated in the family health unit by enrollment of the clientele and active search, and the study showed the lack of a structured network. The study indicates that work processes contemplating the social determination of health and its intersectorality can lead to expanded access to comprehensive care for childbearing-age women.

Estudo avaliativo sobre a expansão da Estratégia Saúde da Família em grandes centros urbanos no Estado do Rio de Janeiro, Brasil, analisando funcionamento das modalidades de atenção, desempenho e oferta de atenção integral em si e em sua articulação com serviços de outro nível. O eixo de análise foi a integralidade do cuidado no cotidiano dos serviços, com foco nas mulheres em idade reprodutiva, tendo a gestação como condição traçadora. Os resultados decorreram de análise permitida pela realização de grupos focais com usuárias e profissionais de saúde, tendo-se em conta: caracterização dos atores; suas percepções sobre saúde, modelo de atenção, forma de organização dos serviços e práticas da atenção primária à saúde. Esses grupos sugeriram que os atores envolvidos percebem a saúde identificada em seus determinantes sociais. O acesso ao serviço e às ações se diferenciou na unidade de saúde da família pela adscrição da clientela e busca ativa, observando-se inexistência de uma rede estruturada. O estudo indica que processos de trabalho que contemplem a determinação social da saúde e a intersetorialidade conduziriam à ampliação do acesso e do cuidado integral da saúde da mulher na fase reprodutiva.

Mothers'health in Brazil and recovering the training of midwives for care in the birth process / El cuidado de la salud materna en Brasil y el rescate de la enseñanza de obstetras para asistencia al parto / O cuidado a saúde materna no Brasil e o resgate do ensino de obstetrizes para assistência ao parto

The authors briefly analyze the situation of maternal health care in Brazil and, based on their findings, they comment that there have been transformations in the health care model for women and families and propose some measures, including recovery of the work of the obstetric nurse or midwife (obstetriz, in Portuguese). They comment that women care tendencies in the delivery process presuppose incorporation of the paradigm of improving the physiology of valuing women's experience, the approach to the family, health advice that prioritizes prevention, education and relationships, without ignoring safety. They appoint that building this health care model, which includes the work of the midwife, may improve maternal health indicators.

Los autores hacen un breve análisis de la situación del cuidado de la salud materna en Brasil, y con base en sus hallazgos, sugieren transformar el modelo de atención a la mujer y a sus familiares; proponen algunas medidas que incluyen la inserción del trabajo de la enfermera obstétrica y de la obstetra en el contexto actual. Comentan sobre la tendencia actual del cuidado materno en el proceso del nacimiento, el cual presupone la incorporación del paradigma que favorece la fisiología y la valorización de la experiencia femenina, el abordaje centrado en la familia con énfasis en la prevención, educación y relación interpersonal sin dejar de lado la seguridad. Consideran que el modelo del cuidado de la salud que incluye el trabajo de la obstetra, puede mejorar los indicadores de salud materna.

Os autores fazem uma breve análise da situação do cuidado a saúde materna no Brasil, e com base nesses dados, apontam as transformações no modelo de assistência à mulher e às famílias e propõem algumas medidas, as quais inclui a inserção do trabalho da enfermeira obstétrica ou obstetriz no contexto atual. Comentam que a tendência atual do processo de nascimento pressupõe a incorporação do paradigma que favorece a fisiologia e a valorização da experiência feminina, a abordagem centrada na família, com ênfase na prevenção, educação e relacionamento interpessoal, sem deixar de lado a segurança. Consideram que o modelo de cuidado à saúde, que inclui o trabalho da obstetriz, pode melhorar os indicadores de saúde materna.

Guía metodológica para la asistencia a mujeres víctimas de violencia / Methodological guidelines to assist women victims of violence

La violencia hacia la mujer es un obstáculo para el logro de la igualdad, la equidad, el desarrollo, la paz y la participación social. Es una violación de los derechos humanos que limita su libertad personal, nulifica las garantías fundamentales como el derecho a la seguridad, a la integridad e incluso a la vida. Sus raíces son multifactoriales, las componen una diversidad de variables que debemos conocer para comprenderlas y analizarlas. Es multicausal y sus repercusiones son sociales e individuales por lo que su abordaje debe ser multidisciplinar e intersectorial. Es multidimensional por lo que su respuesta debe ser global, sistémica y holística desde la prevención, asistencia y protección hasta su recuperación(AU)

Women abuse is an obstacle to achieve equality, development, peace and social inclusion. This is a violation of human rights limiting their personal freedom and annulling their main warranties as their right to have security, integrity and even life. In the 90´ it has been identified as a health problem due to its frequency and severity, its magnitude and influence in health recovery. With the objective of supporting the decrease of this invisible plague from a Public Health perspective, we considered timely and pertinent to adjust a format of Methodological Guidelines aimed at setting rules and unifying procedures, including the complexity and implications of violence, based on the needs of each part(AU)

Midwifery and health disparities: theories and intersections.

In the past decade, the reduction of health disparities has become an important policy agenda in the United States. Clinicians in practice, however, may be unfamiliar with the prevailing causal theories and uncertain about what they can do to help to reduce inequalities in health. The purpose of this article is to provide women's health care clinicians with an overview of the definitions, measurement issues, and theories that fall under the rubric of health disparities. The intersecting roles of genetics, race/ethnicity, environment, and gender are discussed. The article also provides practical suggestions for interventions and health policy change that can be implemented by clinicians in practice.

Women's experiences of and preferences for services after rape in South Africa: interview study.

OBJECTIVES: To describe aspects of delivery of health services after rape, including trade-offs, that would most influence choice of service, and to compare views of patients who had used such services with views of members of the community who may be future users or may have experienced barriers to service use. DESIGN: Discrete choice analysis of stated preferences with interviews. Attributes included travel time to the service, availability of HIV prophylaxis, number of returns to the hospital, medical examination, and counselling skills and attitude of the provider. SETTING: One rural and one urban site in South Africa. PARTICIPANTS: 319 women: 155 who had been raped and four carers recruited through health facilities and 160 comparable women recruited from the community. Of these, 156 were from an urban site and 163 from a rural site. MAIN OUTCOME MEASURES: Strength of preferences over a range of attributes through the estimation of a benefit function through random effects probit modelling. RESULTS: Factors such as the availability of prophylactic treatment for HIV infection and having a sensitive healthcare provider who could provide counselling are more important in women's decisions to seek care after rape than the travel time necessary to access those services. CONCLUSION: Our findings support the need for holistic rape services.

Comparison of movement-to-music, rhythm activities, and competitive games on depression, stress, anxiety, and anger of females in substance abuse rehabilitation.

Over the past several decades the number of females using addictive substances has continuously increased. Females have different reasons for initiating substance abuse and specific treatment needs that differ from males. Researchers suggested gender specific drug rehabilitation treatment, in which female clients developed or improved functional behaviors. The purpose of this study was to investigate the effects of 3 different types of music therapy interventions on levels of depression, stress, anxiety, and anger of female clients in substance abuse rehabilitation. Ten females in an outpatient substance abuse rehabilitation program participated twice a week for 6 weeks in a music therapy program, participating in movement-to-music activities, rhythm activities, and competitive games for 2 weeks, 4 sessions each. After each intervention state-trait anxiety and levels of anger were measured. A repeated-measures ANOVA indicated no significant differences for the three types of music therapy interventions; however, data collected on daily scores, immediately before and after each session, indicated that individuals reported a decrease in depression, stress, anxiety, and anger immediately following the music therapy sessions.