Behavioral barriers to the use of modern methods of contraception among unmarried youth and adolescents in eastern Senegal: a qualitative study.

BACKGROUND: Many unmarried young people in low- and middle-income countries (LMIC) want to avoid pregnancy but do not use modern methods of contraception-as a result, half of teen births in these countries are unintended. Researchers have identified numerous barriers that prevent youth from using contraception. However, much of the research in West Africa is narrowly focused on married women, and relatively little research has been done to understand the needs, preferences, barriers, and solution set for sexually active unmarried young people who would like to avoid pregnancy. The purpose of this study was to gain insight into the behavioral barriers that prevent unmarried young people in eastern Senegal from using modern methods of contraception. METHODS: This qualitative study conducted in 2017 in the Tambacounda and Kedougou regions in Senegal explores attitudes and beliefs relating to sex and contraception among unmarried young women and men through 48 in-depth individual interviews with young people aged 15-24 and parents of youth and 5 sex-segregated focus groups with 6-9 young people per group. The research team conducted a thematic content analysis and synthesized the findings by major theme following the behavioral diagnosis methodology. RESULTS: Drawing insights from behavioral science, the analysis yields five key findings: (1) unmarried young people avoid making a decision about contraception because thinking about contraceptive use provokes uncomfortable associations with a negative identity (i.e., being sexually active before marriage); (2) unmarried young people see modern methods as inappropriate for people like them; (3) unmarried young people are overconfident in their ability to prevent pregnancy through traditional and folk methods; (4) unmarried young people overestimate the social and health risks of modern contraceptive methods; and (5) unmarried young people fail to plan ahead and are not prepared to use modern contraceptive methods before every sexual encounter. CONCLUSIONS: Interventions aimed at increasing uptake of contraceptives among unmarried young people in eastern Senegal must address several significant behavioral barriers in addition to structural, informational, and socio-cultural barriers in order to be successful.

Effects of electroacupuncture on anxiety and depression in unmarried patients with polycystic ovarian syndrome: secondary analysis of a pilot randomised controlled trial.

OBJECTIVE: To evaluate the efficacy of electroacupuncture (EA) for the treatment of anxiety and depression in unmarried patients with polycystic ovarian syndrome (PCOS) by secondary analysis of a randomised controlled trial. METHODS: A prospective pilot randomised controlled trial of unmarried women with PCOS was conducted from November 2012 to March 2016. Participants were assigned to the acupuncture group (receiving EA for 16 weeks) or the control group (receiving sham acupuncture for 16 weeks), with 27 patients in each group. The pre-specified primary outcomes and all secondary outcomes, with the exception of serum levels of neurotransmitters including norepinephrine (NE), epinephrine (AD), serotonin (5-HT) and γ-aminobutyric acid (GABA), will be reported separately. Additional outcome measures selected for this secondary analysis included anxiety and depression scale scores (Zung-SAS and Zung-SDS), 36-Item Short Form (SF-36) scale scores, PCOS Quality of Life (PCOSQOL) scale scores and Chinese Quality of Life (CHQOL) scale scores. RESULTS: After the16-week intervention, an increase in serum NE and reduction in 5-HT were observed in the acupuncture group (P=0.028 and P=0.023, respectively). The serum level of GABA decreased in both groups after the interventions (both P<0.001). However, there were no significant differences between the two groups in the levels of any neurotransmitters (p>0.05). After EA treatment, SAS and SDS scores were decreased in the acupuncture group (P=0.007 and P=0.027, respectively) and were lower than those of the control group (P=0.003 and P=0.004, respectively). The SF-36 domain scores for mental health, vitality, social functioning, general health and health transition, the total CHQOL scores, and the infertility problems and body hair domains of the PCOSQOL improved significantly after EA (P<0.05). CONCLUSION: EA appears to improve symptoms of anxiety/depression and quality of life in PCOS patients and may influence serum levels of NE and 5-HT. These findings should be interpreted with caution, given the secondary nature of the outcome measures reported herein. TRIAL REGISTRATION NUMBER: NCT01812161; ChiCTR-TRC-12002529.

Being a young midwifery student: A qualitative exploration.

BACKGROUND: undergraduate midwifery programmes offer opportunities for school leavers and young people (aged less than 21 years) to enter the profession. There is limited research exploring this age groups experience of their Bachelor of Midwifery programme. In order to retain these students we need to ensure that their experiences of undertaking a Bachelor of Midwifery program are positive and barriers and challenges are minimised. AIM: this study explored young midwifery students' experience of their Bachelor of Midwifery program. METHOD: a descriptive exploratory qualitative approach was used to explore the experiences of eleven students aged 20 years or less on enrolment. Data was collected using face-to-face or telephone-recorded interviews. Thematic analysis was used to analysis the data set. FINDINGS: three major themes described the young students' experiences. The first labelled 'The challenges of being young' presented a number of age related challenges including transport issues with on-call commitments as some students had not gained a driver's license. Students experienced some degree of prejudice relating to their age from their older student peers and some clinical staff during placements. 'Finding your way' was the second theme and described the strategies students used to build confidence and competence both in the university and clinical environment. The young students reported a strong commitment to the profession. They demonstrated high levels of connection with women and found the continuity of care experiences invaluable to their learning. The final theme 'Making the transition from teenager to midwife' demonstrated some unique insights into how studying to become a midwife impacted upon their personal and professional growth. CONCLUSION: the young students in this study encountered some unique issues related to their age. However as they progressed through the program they developed confidence in themselves and visualised themselves as having a long midwifery career. They were strongly motivated towards providing woman-centred maternity care and considered their continuity of care experiences fundamental to them developing a strong sense of themselves as midwives. Attracting and retaining young students is essential if the profession is to realise its goal of ensuring all women have access to a known midwife.

Older people living alone at home with terminal cancer.

This study describes the lived experiences of older people coping with terminal cancer and living alone, focusing on how they face challenges of the biographical life changes from their disease progression. Face-to-face semi-structured interviews were conducted in two phases with palliative care clients of a community-based service in Western Australia (2009-2011): Brief interviews with 43 cancer patients who live alone and then in-depth interviews with 8 of them. Using biographical disruption as the analytical framework for interpreting the qualitative data, four main themes emerged: Biographical disruption: adjusting to change; Biographical continuity: preserving normality; Biographical reconstruction: redefining normality; and Biographical closure: facing the end. Biographical disruption was a suitable framework for analysis, permitting identification of the biographical disruptions of the individual's world and the reframing that is undertaken by the individual to maintain autonomy and independence while acknowledging and accepting their closeness to death. Understanding the factors associated with the individual's need to maintain their own identity will enable nurses working with this population to tailor support plans that meet the individuals' needs while maintaining or restoring the person's sense of self. Interventions that directly address end-of-life suffering and bolster sense of dignity and personhood need to be considered.

Remarriage of war and terror widows: a triadic relationship.

The article focuses on the intimate relationships of remarried Israeli national widows. An analysis of interviews with 15 widows and 12 of their husbands demonstrated the widows' continuing connection to the deceased husband and thus gives further corroboration to the theory of "'continuing bonds'"; husbands also express their relationship as triadic, with the fallen husband assigned a unique position in the family constellation, albeit not threatening to the new husband. The article concludes with specific guidelines for planning therapeutic programs, e.g., recommending clients to use some symbolic objects, either abstract or concrete, to help widows rebuild their self-identity.

[Psyche and immunity. A selected literature study of psychoneuroimmunology in healthy persons]. / Psyche und Immunität. Eine ausgewählte Literaturstudie der Psychoneuroimmunologie bei gesunden Personen.

In the new field of psychoneuroimmunology essential ground has already been broken. Precisely in man, however, only hypotheses are possible in important areas: one that is commonly voiced is that stress weakens the immune system and would favour the onset of disease. A situation report is presented which summarizes, classifies and compares all 67 published studies relating psychic influences to immunologic factors in healthy human beings. A notable proportion turned out to be doubtful from the formal standpoint, e.g. no controls (40 publications) or with fewer than 30 probands (19). In 13 of these studies neuroendocrinologic parameters were taken into account and in 14 biological (health/disease) parameters. 42 studies were based on "externally defined" stress situations (partner loss, examinations, care of severely ill family members, space shuttle mission, etc.), 16 on specific personality traits and 9 on experimental stress situations or relaxation efforts. Since the studies varied widely in design, psychic starting position, psychic assessment (91 different methods) and immunity (68 varying parameters) and also in regard to the biological result (various "endpoints" of health/disease), only a few general conclusions can be drawn. Subjective or objective stress can be associated with diminished lymphocyte functions such as reduced mitogen stimulation and natural killer cell activity, elevated antibody titers against some latent and/or ubiquitous viruses, and reduced immunoglobulin A in saliva. This is confirmed to varying degrees, usually on a shortterm basis and not in all studies. Others contain evidence that the immunologic changes mentioned may be associated with particular personality traits (anxiety, depression, loneliness, good coping, power motive syndrome, social support, etc.). What the immunologic changes had in common was that they moved within a relatively narrow range and overstepped the norm little or only marginally. Whether the immunologic "anomalies" observed reflect a weakened immune system or an adequate "homeostatic" immune modulation by psychic signals, or point to adequate immune defence in an altered "antigen situation" arising from a changed lifestyle in stress situations, cannot be said. There is little evidence of a relationship to disease onset. While the present review shows certain relationships between psychic and immunologic factors, their biological relevance remains unclear. The often voiced hypothesis that stress weakens the immune system and a larger number of diseases therefore ensue cannot be confirmed or denied by the available data. The results permit other, contradictory hypotheses.

The health meanings and practices of older Greek-Canadian widows.

Folk health and illness beliefs and practices were abstracted from a large-scale study of older Greek-Canadian widows conceptualized within Leininger's theory of Cultural Care Diversity and Universality using ethnographic, ethnonursing, and life health-care history methods. Data were collected using observation-participation and interviews in three Greek-Canadian communities with 12 widowed key informants and 30 general informants. Interview inquiry guides, Leininger's Life History Health Care Protocol, and field journal recordings assisted data collection. Data were analysed using Leininger's phases of analysis for qualitative data. A major health theme which was abstracted from the raw data and patterns was: health for Greek-Canadian widows meant a state of well-being, ability to perform daily role activities, and avoidance of pain and illness. The findings, which also included folk health care and illness beliefs and practices, will stimulate future nursing research related to health and nursing care of people of diverse cultures.