Exploring the Role of Irrational Beliefs, Lifestyle Behaviors, and Educational Status in 10-Year Cardiovascular Disease Risk: the ATTICA Epidemiological Study.

BACKGROUND: Irrational beliefs, maladaptive emotions, and unhealthy lifestyle behaviors can adversely affect health status. However, limited research has examined the association between irrational beliefs and cardiovascular disease (CVD). The aim of this study was to evaluate the association between irrational beliefs and the 10-year CVD incidence among apparently healthy adults, considering the potential moderating or mediating role of particular social and lifestyle factors. METHODS: The ATTICA study is a population-based, prospective cohort (2002-2012), in which 853 participants without a history of CVD [453 men (aged 45 ± 13 years) and 400 women (aged 44 ± 18 years)] underwent psychological evaluations. Among other tools, participants completed the irrational beliefs inventory (IBI, range 0-88), a self-reported measure consistent with the Ellis model of psychological disturbance. Demographic characteristics, detailed medical history, dietary, and other lifestyle habits were also evaluated. Incidence of CVD (i.e., coronary heart disease, acute coronary syndromes, stroke, or other CVD) was defined according to the International Coding Diseases (ICD)-10 criteria. RESULTS: Mean IBI score was 53 ± 2 in men and 53 ± 3 in women (p = 0.88). IBI score was positively associated with 10-year CVD risk (hazard ratio 1.07, 95%CI 1.04, 1.13), in both men and women, and more prominently among those with less healthy dietary habits and lower education status; specifically, higher educational status leads to lower IBI score, and in conjunction they lead to lower 10-year CVD risk (HR for interaction 0.98, 95%CI 0.97, 0.99). CONCLUSIONS: The findings of this study underline the need to build new, holistic approaches in order to better understand the inter-relationships between irrational beliefs, lifestyle behaviors, social determinants, and CVD risk in individuals.

Uso de terapias de medicina alternativa y complementaria en la provincia de Coronel Portillo, Ucayali, Perú / Use of complementary and alternative medicine therapies in the province of Coronel Portillo, Ucayali, Peru

RESUMEN Se realizó un estudio transversal con el objetivo de evaluar el uso de terapias de medicina alternativa y complementaria (MAC) y sus factores asociados, en la provincia de Coronel Portillo (Ucayali), durante el 2013. Se realizaron 917 encuestas a los jefes de hogar, residentes en tres distritos de la provincia (Callería, Manantay y Yarinacocha), en las que se calculó la proporción de uso de MAC y se analizó la relación con variables sociodemográficas (edad, sexo, grado de instrucción, estado civil, ocupación e ingreso económico). 179 encuestados (19,5%) mencionaron que utilizaron MAC en los últimos doce meses. Se encontró una relación estadísticamente significativa entre el uso de terapias de MAC y el grado de instrucción (p < 0,001), la ocupación de la persona encuestada (p < 0,001) y su ingreso económico mensual (p < 0,001). Futuras investigaciones definirán las asociaciones encontradas y las variables intervinientes.

ABSTRACT A cross-sectional study was carried out to evaluate the use of complementary and alternative medicine (CAM) therapies and the factors associated with it, in the province of Coronel Portillo (Ucayali) during 2013. A total of 917 surveys were carried out among household heads in three districts of the province (Callería, Manantay and Yarinacocha), in which the proportion of CAM use was calculated and the relationship with sociodemographic variables (age, sex, educational level, marital status, occupation and income) was analyzed. From the total, 179 respondents (19.5%) mentioned that they used CAM in the last 12 months. A statistically significant relationship was found between the use of CAM therapies and educational level (p < 0.001), respondent's occupation (p < 0.001) and monthly income (p < 0.001). Future research will define the found associations and the variables involved.

[Awareness, Treatment and Control of Hypertension in Population Aged 16 to 90 Years Old in the Valencia Region, Spain, 2010]. / Conocimiento, tratamiento y control de la hipertensión arterial por las personas de 16 a 90 años de edad participantes en la Encuesta de Nutrición de la Comunitat Valenciana de 2010.

OBJECTIVE: Hypertension is an important risk factor in terms of mortality attributable and the main modifiable cardiovascular risk factor. The aim of the study is to estimate the degree of awareness, treatment and control of hypertension in population of Valencia Region and identify predictors that explain the lack of proper control. METHODS: Cross-sectional population-based study in 413 men and 415 women between 16 and 90 years participants in Nutrition Survey of Valencia held in 2010. Automatic sphygmomanometer was used for taking blood pressure. Hypertension was defined according to the criteria of 2007 European Society of Hypertension and the European Society of Cardiology. Data on knowledge and treatment were obtained by survey. Predictors for awareness, treatment and control of hypertension were estimated by logistic regression models. RESULTS: The prevalence of hypertension estimated for the study population was 38.2% (95% CI: 34.9%-41.5%). 51.4% (95% CI: 45.9%-57.0%) of the hypertensive population, knew his condition. 88.8% of them (95% CI: 83.9%-93.6%) were receiving drug therapy and of these, 45.1% (95% CI: 36.9%-53.3%) maintained blood pressure controlled. CONCLUSIONS: Since the last survey in Valencia Region, the degree of awareness of hypertension has not improved although an increase in those treated with antihypertensive drugs is observed.

Hepatitis B-Related Concerns and Anxieties Among People With Chronic Hepatitis B in Australia.

BACKGROUND: The psychological wellbeing of people with chronic hepatitis B (CHB) may be negatively affected due to the chronic and transmissible nature of the disease, and possible serious complications (e.g. cirrhosis and liver cancer). There are limited data investigating concerns and anxieties among people living with CHB. OBJECTIVES: This study examined feelings about having hepatitis B among people with CHB, including hepatitis B-related concerns and anxieties. PATIENTS AND METHODS: Using convenience sampling, people with CHB attending four public liver clinics and one general practice in three Australian jurisdictions between April and September 2013 completed a self-administered questionnaire about their feelings about having hepatitis B. RESULTS: Ninety-three people completed the survey. Mean age was 45 years, 57% were men, and 93% were born overseas (75% from Asia). Seventy-six percent of participants reported having hepatitis B-related concerns and anxieties. The most common concerns were of developing liver cancer (57%), and infecting other people (53%). Thirty-five percent of participants were unwilling to talk to anyone about their hepatitis B while 25% changed how they lived as a result of having hepatitis B. Lower educational level was associated with feeling scared of hepatitis B (adjusted Odds Ratio [OR]: 4.04; 95%CI: 1.09, 14.90; P = 0.04), and an unwillingness to talk to anyone about hepatitis B (adjusted OR: 4.41; 95%CI: 1.09, 17.83; P = 0.04). Very good English proficiency was associated with a higher likelihood of participants changing how they lived (adjusted OR: 12.66; 95%CI: 2.21, 72.42; P < 0.01), and seeing life differently as a result of having hepatitis B (adjusted OR: 21.10; 95%CI: 3.70, 120.19; P < 0.01). Health professionals were the key person for 34% of participants in helping them cope with having hepatitis B, while 18% reported that no one supported them. CONCLUSIONS: Hepatitis B-related concerns and anxieties are prevalent among people with CHB. Clinical management of people with CHB must address their psychological support needs as an essential component of comprehensive care.

Influence of year-on-year performance on final degree classification in a chiropractic master's degree program.

OBJECTIVE: We explored if any predictors of success could be identified from end-of-year grades in a chiropractic master's program and whether these grades could predict final-year grade performance and year-on-year performance. METHODS: End-of-year average grades and module grades for a single cohort of students covering all academic results for years 1-4 of the 2013 graduating class were used for this analysis. Analysis consisted of within-year correlations of module grades with end-of-year average grades, linear regression models for continuous data, and logistic regression models for predicting final degree classifications. RESULTS: In year 1, 140 students were enrolled; 85.7% of students completed the program 4 years later. End-of-year average grades for years 1-3 were correlated (Pearson r values ranging from .75 to .87), but the end-of-year grades for years 1-3 were poorly correlated with clinic internship performance. In linear regression, several modules were predictive of end-of-year average grades for each year. For year 1, logistic regression showed that the modules Physiology and Pharmacology and Investigative Imaging were predictive of year 1 performance (odds ratio [OR] = 1.15 and 0.9, respectively). In year 3, the modules Anatomy and Histopathology 3 and Problem Solving were predictors of the difference between a pass/merit or distinction final degree classification (OR = 1.06 and 1.12, respectively). CONCLUSION: Early academic performance is weakly correlated with final-year clinic internship performance. The modules of Anatomy and Histopathology year 3 and Problem Solving year 3 emerged more consistently than other modules as being associated with final-year classifications.

Practitioner and Practice Characteristics of Certified Professional Midwives in the United States: Results of the 2011 North American Registry of Midwives Survey.

INTRODUCTION: No data describing certified professional midwives (CPMs) currently exist in the literature, although CPMs attend the majority of home births in the United States. This study addresses this gap by assessing the demographics, education levels, routes to certification, and practice characteristics of currently practicing CPMs. METHODS: Data were collected from a survey of CPMs conducted by the North American Registry of Midwives (NARM) between July and October 2011. In order to assess generalization to the entire population of practicing CPMs, we also completed a nonresponse bias analysis. We examined midwives' demographic, education, certification, and practice characteristics using descriptive and nonparametric, bivariable statistics. RESULTS: More than 90% of the 568 respondents attended at least some college, and 47.1% hold a bachelor's degree or greater. CPMs spent a median of 3 years (interquartile range, 2-5 years) in training before attending births as a primary midwife. However, 38.9% of currently practicing CPMs had less than 3 years of training. Regarding pathways to certification, 48.5% utilized the portfolio evaluation process (PEP); 36.9% graduated from a Midwifery Education and Accreditation Council (MEAC)-accredited school; 14.5% were already licensed by a state as a direct-entry midwife; and 0.7% were already a certified nurse-midwife or certified midwife, although many CPMs reported a blended education pathway. One-fifth (21%) of respondents identified as midwives of color. Whereas nearly one-third (31.8%) of CPM respondents reported that 95% or more of their clients were white, 5.2% serve populations that are 90% or more nonwhite. CPMs of color are significantly more likely to serve clients of color (P < .001). DISCUSSION: Training and nonmidwifery education levels of most CPMs practicing in the United States align with the Global Standards for Midwifery Education established by the International Confederation of Midwives, although there are still clear areas for improvement.

Enfrentamentos da criança com câncer frente ao afastamento escolar devido internação hospitalar / Enfrentamientos del niño con cáncer frente al alejamiento de la escuelacuando hospitalizado / Coping of children with cancer on school removal because of hospitalization

Objetivo: identificar os enfrentamentos de crianças com câncer frente ao afastamento do ambiente escolar devido à internação hospitalar. Método: pesquisa qualitativa, desenvolvida em um Hospital Universitário do interior do estado do Rio Grande do Sul, no período de outubro a novembro de 2007, com o emprego da entrevista semiestruturada com nove crianças, com análise de conteúdo. Resultados: emergiram duas categorias temáticas: “Dificuldades referentes ao desenvolvimento escolar da criança: do diagnóstico ao tratamento”, a qual permitiu perceber a influência das restrições impostas pela doença e pelo tratamento na vida escolar e “Apoio e estímulo para a continuidade escolar”, na qual foram mencionados os familiares, escola de origem e classe hospitalar.Conclusões: a pesquisa permitiu refletir sobre os enfrentamentos dessas crianças ao se depararem com o afastamento do convívio escolar, sendo relevante os profissionais de enfermagem atentarem para os mesmos, a fim de proporcionar uma assistência integral à esta clientela.

Aim: to identify coping of the children with cancer on being removed from school life because of hospitalization. Method: research with a qualitative approach, developed in a University Hospital in the state of Rio Grande do Sul, from October to November 2007, with the use of semi structured interviews with nine children and of content analysis. Results: two thematic categories emerged: “Difficulties referred to thechild’s school performance: of the diagnosis to the treatment” and “Support and stimulus to staying in school”, in which it was mentioned the relatives, school of origin and hospital type. Conclusions: thinking about the clashes of these children when across with the removal of the school life is relevant to nursing professionals as also being attention to them, in order to provide comprehensive care to these clients being relevant.

Objetivo: identificar los enfrentamientos de los niños con cáncer frente al alejamiento del ambiente escolar debido a la hospitalización. Método: investigación cualitativa, desarrollada en un hospital universitario en el estado de Rio Grande do Sul,entre Octubre y Noviembre de 2007, usando entrevistas semiestructuradas a nueve niños,y análisis de contenido. Resultados: surgen dos categorías temáticas: “Dificultades referentes al desarrollo escolar del niño: del diagnostico al tratamiento” y “Apoyo yestimulo para la continuidad escolar”, en la que fueron mencionados los familiares, escuela de origen y clase hospitalar. Conclusiones: la investigación permitió reflexionar sobre los enfrentamientos de esos niños cuando alejados de la conviviencia escolar, siendorelevante que los profesionales de enfermería estén atentos a ellos, con el fin de brindaruna atención integral a esta clientela.

A influência da escolaridade na reprodutibilidade de um questionário quantitativo de frequência alimentar para gestantes / The influence of level of schooling on the reproducibility of a quantitative food frequency questionnaire among pregnant women

Avaliar a influência da escolaridade sobre a reprodutibilidade de um questionário de frequência alimentar (QQFA), previamente desenvolvido para gestantes, na estimativa de nutrientes durante a gestação. MÉTODOS: o QQFA foi aplicado em duplicata (entre 15 e 45 dias) em uma amostra de 95 gestantes. Análises de coeficiente de correlação intraclasse (CCI) e classificação das gestantes em quartis de estimativa de nutrientes, estratificadas por 8 anos de estudo, foram empregadas. RESULTADOS: após ajuste pela energia, o CCI médio foi de 0,66 (variando de 0,33 para ácido graxo linoléico e 0,88 para potássio e folato) e 0,72 (variando entre 0,44 para ácido graxo araquidônico e 0,84 para potássio) entre as aplicações do QQFA para gestantes com menor e maior escolaridade, respectivamente. Em média, 78 por cento e 84 por cento das gestantes foram classificadas no mesmo quartil ou quartil adjacente entre as aplicações do QQFA para gestantes com menor e maior escolaridade, respectivamente. CONCLUSÕES: o questionário apresentou boa precisão na estimativa de nutrientes durante a gestação, exceto para alguns ácidos graxos. Verificou-se maior precisão do QQFA na estimativa de nutrientes entre mulheres com escolaridade correspondente a mais de 8 anos de estudo...

To evaluate the influence of level of schooling on the reproducibility of a quantitative food frequency questionnaire (QQFA), previously designed for pregnant women, to estimate nutrient intake pregnancy. METHODS: the QQFA was applied in duplicate (between 15 and 45 days) to a sample of 95 pregnant women. The intra-class correlation coefficient (CCI) was calculated and the pregnant women classified into quartiles of nutrient estimates, stratified by eight years of schooling. RESULTS: after adjustment for energy, the mean CCI was 0.66 (varying between 0.33 for linoleic fatty acid and 0.88 for potassium and folate) and 0.72 (varying from 0.44 for arachidonic fatty acid to 0.84 for potassium) among applications of the QQFA to pregnant women with lower and higher levels of schooling, respectively. On average, 78 percent and 84 percent of pregnant women were classified in the same quartile or in adjacent quartiles on subsequent applications of the QQFA to pregnant women with lower and higher levels of schooling, respectively. CONCLUSIONS: the questionnaire presented a high level of precision in estimating nutrient intake during pregnancy, except for some fatty acids. The QQFA was shown to be more accurate among women with more than eight years of schooling...

Fatores associados ao uso de suplemento de ácido fólico durante a gestação / Factors associated with folic acid use during pregnancy

OBJETIVO: Estimar a prevalência de consumo de suplemento de ácido fólico durante a gestação e identificar os fatores associados ao seu consumo. MÉTODOS: Estudo transversal que incluiu 280 mulheres da cidade de Diamantina (MG). A variável dependente foi o uso de suplemento de ácido fólico, e as independentes, a idade e escolaridade materna, paridade, número de consultas de pré-natal, situação marital e presença ou não de anemia. Utilizou-se análise de regressão de Poisson para avaliar a associação das variáveis independentes com a variável dependente. RESULTADOS: Mulheres com menor escolaridade, adolescentes e com número de consultas de pré-natal inferior a sete apresentaram, respectivamente, 1,61 (IC95 por cento=1,34-1,93), 1,18 (IC95 por cento=1,03-1,35) e 1,18 (IC95 por cento=1,02-1,37) mais chances de não consumir o suplemento durante a gestação. CONCLUSÃO: A prevalência de consumo de ácido fólico entre as gestantes foi baixa e associada à idade, escolaridade materna e ao número de consultas pré-natal.

PURPOSE: To estimate the prevalence of folic acid supplementation during pregnancy and to identify maternal factors associated with its consumption. METHODS: This was a cross-sectional study with 280 women from the city of Diamantina (MG), Brazil. The dependent variable was use of a folic acid supplement during pregnancy, and the independent variables were age and maternal schooling, number of prenatal care visits, parity, marital status and presence or absence of anemia. Poisson regression analysis was used to assess the association of independent variables with the dependent variable. RESULTS: Women with less education, adolescents, and number of prenatal visits less than seven were 1.61 (95 percentCI=1.34-1.93), 1.18 (95 percentCI=1.03-1.35) e 1.18 (95 percentCI=1.02-1.37) more likely not to consume the supplement during pregnancy, respectively. CONCLUSIONS: The prevalence of consumption of folic acid among pregnant women was low, associated with maternal age and education and number of prenatal visits.

Opium use in a rural area of the Islamic Republic of Iran

Because of its geographic proximity to the major drug production centres, there is easy access to narcotic drugs in the Islamic Republic of Iran despite efforts by governmental and nongovernmental organizations. Using a structured questionnaire as a basis for conversation, local health workers interviewed 310 residents of a rural area in Babol province about opium use. The self-reported rate of opium use, adjusted due to a bias in the sex ratio of the sample, was 8.9%. All the 42 opium users reported opium use at least 2-3 times per week in the previous 3 months. Opium was smoked by 95.2% and taken orally by 4.8%; there was no injecting use. There was no reported use of other substances, including alcohol. There was a statistically significant relationship between opium use and male sex, unemployment and cigarette smoking

Patterns of belief and use of traditional remedies by diabetic patients in Mecca, Saudi Arabia

A sample of 1039 diabetic patients in Saudi Arabia was interviewed using a structured questionnaire about belief in traditional herbal remedies. The relationship of belief scores to sociodemographic and diabetes-related variables was assessed using chi-square tests. The study showed that 15.6% of the sample believed that traditional medicines were safe and effective and 25.8% that they might be beneficial. One-third of patients were using traditional remedies. A statistically significant relationship was shown between belief in traditional medicines and variables such as female sex, positive family history of diabetes, duration of diabetes and compliance with diet. However, there was no relationship with other compliance variables or with glucose and weight control. Efforts should be made to enhance diabetic education among patients on the basis of evidence-based practice

Traditional healers in the Qazvin region of the Islamic Republic of Iran: a qualitative study

We identified and categorized by method of therapy 15 traditional healers in the recorded by actual patients or by observers simulating a medical condition. The treatment practices of the 15 healers [8 men and 7 women] included herbal remedies [four], bone-setting [five], traditional methods for the treatment of sore throat [two], massage therapy using plant oils [one], cupping [two], and leech therapy [one]. Despite an adequate number of physicians practising in the region, traditional healers continue to be consulted. We recommend that the efficacy of their treatments be further studied and that they be encouraged to contribute positively to the broader health objectives of Iranian society

Characteristics of visitors to traditional healers in central Sudan

Traditional healing is widespread in Sudan and traditional healers are well respected by the community. This study aimed to assess the characteristics of visitors attending traditional healers, the reasons for visits, the frequency of visits, satisfaction with visits and advantages and disadvantages of visits. The results showed that children under ten years did not take part in visits; most of the visitors were between 21 and 40 years [61%] and were women [62%]. Visitors were less educated compared to the general population in the area. The main reasons given for attending traditional healers were treatment [60%] and blessing [26%]. Visitors did not mention any disadvantages to visiting traditional healers

Dead mothers and injured wives: the social context of maternal morbidity and mortality among the Hausa of northern Nigeria.

Northern Nigeria has a maternal mortality ratio greater than 1,000 maternal deaths per 100,000 live births. Serious maternal morbidity (for example, vesico-vaginal fistula) is also common. Among the most important factors contributing to this tragic situation are: an Islamic culture that undervalues women; a perceived social need for women's reproductive capacities to be under strict male control; the practice of purdah (wife seclusion), which restricts women's access to medical care; almost universal female illiteracy; marriage at an early age and pregnancy often occurring before maternal pelvic growth is complete; a high rate of obstructed labor; directly harmful traditional medical beliefs and practices; inadequate facilities to deal with obstetric emergencies; a deteriorating economy; and a political culture marked by rampant corruption and inefficiency. The convergence of all of these factors has resulted in one of the worst records of female reproductive health existing anywhere in the world.

PIP: This study describes the social context of maternal mortality (MM) and morbidity among the Hausa of Northern Nigeria. The analysis is based on a literature review and anthropological field research conducted in southern Katsina in 1975-77, 1994, and 1996. A study during 1975-79, at Ahmadu Bello University Teaching Hospital in Hausaland, found that the most common causes of MM were bacterial infection, pregnancy-induced hypertension and consequences, hemorrhage, anemia, and obstructed labor. The most common pattern was the interaction of two or more complications. Case fatality rates were high among teenage girls with complications; women older than 30 years with eclampsia; and women with uterine rupture. MM was highly correlated with maternal age, total number of pregnancies, absence of prenatal care, lack of formal education, and Hausa-Fulani ethnicity. The MM ratio among Hausa-Fulani was 3180 deaths/100,000 live births. Obstetric fistulas may affect nearly 250,000 women in northern Nigeria. Many other related problems occur. Estimated obstructed labor cases were 1238/100,000 births. The social context that contributes to high mortality and morbidity includes Islamic culture that undervalues women; control of women by men; seclusion of wives that limits access to medical care; female illiteracy; early marriage and pregnancy; high rates of obstructed labor; directly harmful traditional medical beliefs and practices; inadequate facilities to treat obstetric emergencies; a declining economy; and a corrupt, inefficient political culture. Men need to be educated about the reproductive health of Hausa women.

Full development. Women need to be empowered and their status raised for the advancement and development of the whole society. Nigeria.

PIP: This article briefly touches on the issues of the changing nature of development, sustainable approaches to development, and women's role in development. The article discusses and identifies social and cultural factors that constrain women's social development: son preference, inequality in education, poverty, nonrecognition of women's multiple roles, lack of information, discriminatory social practices and customary laws, and nonrecognition of women's rights as human rights. It is suggested that appropriate strategies for empowering women are the provision of adequate and better access to resources, alleviation of urban poverty through a holistic approach, advancement of girl's education, promotion of women in development, more mass media support, and male support. The government of Nigeria is working to actualize democracy, but more attention should be paid to involve women and to advance women by eliminating constraints that discourage women's development and empowerment. An institutional framework must be in place in the private and public sector in order to ensure that women's rights are not denied. Action should come from partnerships between government, nongovernmental organizations, and men and women themselves. Policies relating to women should be relevant, effective, acceptable, and sustainable to all parties. The government has a moral duty to raise, allocate, and reorganize public resources and to mobilize people to act in the interests and betterment of women and society. In Nigeria, the legislative framework should support equal participation of women in socioeconomic and political areas.^ieng

Sociocultural aspects of haemorrhage in pregnancy.

The knowledge, attitudes and practices of rural women in southern Nigeria are at least as important as the availability of modern obstetric care in the fight against haemorrhage in pregnancy. Community-based interventions taking this into account are necessary if the considerable mortality associated with the condition is to be significantly reduced.

PIP: Recent observations in southern Nigeria revealed that there was a lack of knowledge of the warning signs and risk factors associated with hemorrhage during pregnancy, delivery, and the postnatal period; certain food taboos were disadvantageous to pregnant women; there was a belief that supernatural forces caused some cases of maternal hemorrhage and precluded effective modern treatment; and women suffering from hemorrhage continued to seek care from traditional sources. Therefore, focus groups were convened with women, men, and traditional birth attendants in the Ekpoma group of 13 villages from March 1989 to June 1990 to discuss local ideas about hemorrhage and the situations when a pregnant woman may bleed, use and accessibility of interventions, and strategies for community health education. After analyzing the findings, the following actions were taken by the end of 1992: facilities in the first referral hospital were upgraded; a revolving drug fund was established; an emergency transport loan scheme was established; medical officers, nursing staff, medical records officers, and laboratory technicians were given retraining and refresher courses; and the hospital staff was mobilized and reoriented. In addition, and community education and mobilization efforts were continued until 1995. Additional focus group discussions were held between 1993 and 1995. Comparison of the results of the first and second series of focus groups revealed that age, sex, and education had no effect on knowledge, attitudes, and practices. A marginal decline in traditional beliefs had occurred, but postpartum bleeding continued to be induced. The use of modern obstetric care facilities increased threefold from 1993 to 1995. In addition, midwives began referring patients for hemorrhage more readily. Sustained community educational efforts could build on these modest results.

A partnership for women.

PIP: This article reports on the progress of the Brazil National Commission on Population and Development in achieving the mandates of the Cairo Conference on Population and Development's Plan of Action. The Commission is headed by a feminist demographer, Elza Berquo, and includes experts from all government ministries and 8 members from civic and academic institutions. It is preceded in its efforts by the Commission for the Study of Human Reproductive Rights during the 1980s and the National Women's Rights Council, which contributed to the inclusion into the Constitution in 1988 of the principle of family planning provision within the health sector. The new Commission will analyze the demographic impact of public and private policies and initiatives on the quality of life, among other areas. The Commission plans to promote teaching and training on population and development. Initial steps were taken to acquire data sets from various ministries that pertain to development and population. Catholic objections were met with statistics on high teenage pregnancy and the need for health education among youth. The Catholic Church agreed to reconsider its position. Brazil had a total fertility rate in 1996 of 2.5 children per woman, and 40% of reproductive age women were sterilized. The high rate of sterilization is attributed to the high rate of cesarean section and performance of joint procedures. Legal abortion is available when pregnancy results from rape or endangers the life of the mother. The Ministry of Health is criticized for not implementing the Women's Integrated Health Care Program (PAISM) throughout the country. 75% of the population is without health insurance, and the PAISM would improve the health of women and children and increase health budget savings. The Commission will provide links with international donors and nongovernmental groups.^ieng

Training for empowerment? A comparative study of nonformal education for women in small island countries.

PIP: This article compares nonformal education (NFE) and training options for women among the small island countries of Fiji, Kiribati, Niue, Tonga, Barbados, Grenada, St. Lucia, and St. Vincent. Data were obtained from 4 groups (the government agency for women, the national women's organization, a nongovernmental organization, and the university extension center) that operated an NFE course during 1992-94. Interviews were conducted among the tutor and 5 women from the selected NFE programs who had attended research workshops. Over 200 women were interviewed. Caribbean country NFE programs included a varied program of instruction that included, for example, self-defense, assertiveness training, and women-in-trade programs. South Pacific training programs included, for example, training of trainers, leadership training, women and traditional medicine, and women in development. Regional papers in preparation for the 1995 Beijing Conference included research findings on NFE, including workshop findings. Facilitators from Niue and Tonga were more satisfied with women's status in their countries than those in Fiji and Kiribati, but women in all 4 countries said things were changing. Women reported benefits from NFE programs such as new information, acquiring new skills, visiting new places, and sharing experiences with other women. In Kiribati and Tonga, women were disappointed in lack of follow-up. Caribbean women were self-aware, but gained insight into their lack of rights and justice. Not all programs empowered women. NFE providers and participants were unable to identify significant outcomes.^ieng

Mining industry enters a new era of AIDS prevention. Eye witness: South Africa.

PIP: Miners in South Africa are now more at risk of contracting human immunodeficiency virus (HIV) than of being in a mining accident. Some epidemiologists predict that the mines could be experiencing 12,000-40,000 deaths related to acquired immunodeficiency syndrome (AIDS) by 2010. In 1986, HIV infection among mineworkers was 1/3500. Gencor medical personnel now estimate that 20% of the company's employees are HIV-positive and that 30 workers are dying of AIDS each month. In August 1995, the Chamber of Mines, the World Bank, and the World Health Organization (WHO) held a seminar to discuss the potential impact of the epidemic; it was followed by a workshop, "Research Needs and Priorities for the Management of HIV/AIDS Transmission in the Mining Industry," which was organized by the Epidemiology Unit in Johannesburg. Although the seminar invited no people with HIV, mineworkers, or government representatives, the workshop did; however, no representatives of the National Union of Mineworkers (NUM), or the Chamber of Mines, came. In spite of this, a new, holistic approach to HIV-prevention is emerging in the mining sector. A decade of education has not changed risk behaviors, so more emphasis will be placed on outreach programs to the communities, including the prostitutes, with which the miners interact, and on treatment of sexually transmitted diseases (STDs). The mining sector is in a unique position to fight HIV because it already has an extensive medical infrastructure with the capacity to treat STDs effectively, a unionized workforce to provide a pool of peer educators, and recruitment agencies to extend HIV-prevention into rural areas. Obstacles to effective HIV/AIDS education include discrimination (Workers are tested for HIV without consent, and dismissed, if found to be positive, regardless of union agreements.); a psychological factor that is related to underground work and produces recklessness; poor living conditions; and illiteracy. Many myths remain about the cost of improving social conditions and introducing HIV-prevention programs.^ieng

Health information for the grass roots.

In its endeavours to achieve the health-for-all goals, Sierra Leone confronts many formidable obstacles, among the greatest of which are illiteracy and poverty. Nevertheless, determined efforts are being made to disseminate health messages, including advice on self-help in the prevention of diseases and accidents and in tackling illness and disability.

PIP: In developing countries such as Sierra Leone, health education is compromised by the high level of illiteracy. Even when patients are literate, they may not retain health information because it is provided at the wrong level or through an inappropriate medium. Several voluntary health organizations in Sierra Leone have developed innovative projects to disseminate health information to the grass-roots level. For example, the Christian Health Association held a series of workshops for community health officers, community health nurses, welfare workers, and maternal-child health aides. Participants then returned to their villages and explained the content to village elders, religious leaders, traditional healers, and traditional birth attendants. Nurses from the Marie Stopes Society visit market women and small traders who, because of their hours of work, cannot attend clinics or health talks. In addition, the Society is using music as the medium for delivering health messages to Liberian refugees. The Women's Development Movement, in collaboration with the Federation of Muslim Women, has set up cooperatives and organized workshops, film showings, and drama exhibitions to convey family planning messages. Finally, rural resource centers stocked with documents on agriculture, small businesses, appropriate technology, and community health have been established. Key to the success and sustainability of these projects has been community involvement.