Disabled women's attendance at community women's groups in rural Nepal.

There is strong evidence that participatory approaches to health and participatory women's groups hold great potential to improve the health of women and children in resource poor settings. It is important to consider if interventions are reaching the most marginalized, and therefore we examined disabled women's participation in women's groups and other community groups in rural Nepal. People with disabilities constitute 15% of the world's population and face high levels of poverty, stigma, social marginalization and unequal access to health resources, and therefore their access to women's groups is particularly important. We used a mixed methods approach to describe attendance in groups among disabled and non-disabled women, considering different types and severities of disability. We found no significant differences in the percentage of women that had ever attended at least one of our women's groups, between non-disabled and disabled women. This was true for women with all severities and types of disability, except physically disabled women who were slightly less likely to have attended. Barriers such as poverty, lack of family support, lack of self-confidence and attendance in many groups prevented women from attending groups. Our findings are particularly significant because disabled people's participation in broader community groups, not focused on disability, has been little studied. We conclude that women's groups are an important way to reach disabled women in resource poor communities. We recommend that disabled persons organizations help to increase awareness of disability issues among organizations running community groups to further increase their effectiveness in reaching disabled women.

Water and sanitation issues for persons with disabilities in low- and middle-income countries: a literature review and discussion of implications for global health and international development.

The critical importance of unrestricted access to clean drinking water and basic sanitation for all is highlighted in Millennium Development Goal 7, which calls for the reduction by half of the proportion of people without such access by 2015. Unfortunately, little attention has been paid to the needs of such access for the one billion people living with a disability worldwide, despite the fact that the right to equal access for all international development initiatives is guaranteed in the new United Nations Convention on the Rights of Persons with Disabilities. In this paper, we review what is currently known about access to water and sanitation for persons with disabilities in low- and middle-income countries from the perspective of both international development and global health, and identify existing gaps in research, practice and policy that are of pressing concern if the water and sanitation needs of this large - and largely overlooked - population are to be addressed.

HIV/AIDS and disability: differences in HIV/AIDS knowledge between deaf and hearing people in Nigeria.

PURPOSE: Studies both in North America and Europe have found that deaf individuals lack access to AIDS information, due to problems in communication, low literacy and tightly woven social networks within the deaf community. However few comparable studies are available from countries in the Developing World. The present study was undertaken in Nigeria where there is an estimated adult HIV prevalence rate of 5.4%. We sought to compare HIV knowledge among deaf and hearing individuals in order to identify how effectively deaf members of the community are being reached by HIV/AIDS messages. METHODS: A survey comparing knowledge about HIV/AIDS among deaf and hard of hearing adolescents (n = 50) and young adults (n = 50) was undertaken. RESULTS: Significant differences (p < 0.05) in levels of understanding about certain aspects of how AIDS is spread were identified as well as differences in available resources for access to accurate information among deaf members of the population. CONCLUSION: These findings from Nigeria speak strongly to the need for the development of interventions that include people with disabilities in public health and HIV/AIDS strategies and that address their specific vulnerabilities. Evaluating the adaptation of education material and the inclusion of the deaf population in HIV awareness programmes is an urgent 'next step.'

Multiculturalism, chronic illness, and disability.

To gain at least an initial understanding of the underlying beliefs and attitudes in a cross-cultural situation, we believe that the three key points discussed in this paper should prove a significant point of departure: 1. Traditional beliefs about the cause of chronic illness or disability will play a significant role in determining family and community attitudes toward individuals with a disability and will influence when, how, and why medical input is sought. 2. The expectation of survival on the part of parents and community will have an effect on the amount of time, energy, and cooperation shown by family and community for the individual who has an impairment. 3. The expectations by family and community for the social role(s) and individual with a chronic illness or disability will hold will affect a broad range of issues, including education, social integration, and independence. Furthermore, although chronic illness and disability are often considered as issues distinct from the full range of problems encountered in society for immigrant and minority groups, in fact, these issues could not be more closely tied. The frequently discussed concerns within the ethnic and minority community about the role of the family, integration and acculturation, social articulation with the greater American society, stress, cross-cultural misunderstanding, and outright prejudice can all compound the problems encountered for the chronically ill or disabled individual in a multicultural society.

Sociocultural influences on disability status in Puerto Rican children.

BACKGROUND AND PURPOSE: This article describes culturally defined meanings of childhood function and disability in Puerto Rico to provide a context for the interpretation of test scores from the Spanish translation of the Pediatric Evaluation of Disability Inventory (PEDI). SUBJECTS AND METHODS: More than 600 Puerto Rican teachers, parents and caregivers of children with and without disabilities, and members of the general community participated in ethnographic interviews, which were designed to describe their beliefs, attitudes, and knowledge about childhood function and disability. RESULTS: Qualitative and quantitative data analysis confirmed that differences exist between Puerto Ricans and the norms established in the United States for the performance of functional skills by children, and the analysis also described Puerto Rican beliefs and attitudes toward disability. DISCUSSION AND CONCLUSION: Puerto Rican values of interdependence, añoñar (pampering or nurturing behaviors), and sobre protectiva (overprotectiveness) influence parental expectations for the capability of children with disabilities and should be considered when interpreting scores from the PEDI and establishing plans of care. Additional research is needed on the influence of contextual variables on child development and behavioral adaptations to disability.

Counseling and educational interventions for women with genital human papillomavirus infection.

Human papillomavirus (HPV) genital infection is a sexually transmitted disease that affects a large proportion of college-aged women. In addition to the distressing medical aspects of HPV infection, sometimes including lengthy and painful treatments, symptom recurrence, a lack of a definitive cure, and its potential for malignant transformation, HPV also results in significant emotional and psychosexual sequalae for the patient. Concurrent with the range of negative emotions experienced by the patient is also a knowledge deficit regarding the disease, its prevention, and its management. This combination of factors within the young women afflicted with this disease often precludes them from effective adherence to their treatment and follow-up plan of care, which are both essential elements in managing this chronic condition. Clinicians who are treating patients with HPV infection must address not only the medical aspects of the disease, but the psychosocial needs as well. This case report describes a newly diagnosed young women with HPV infection and discusses the necessary psychosocial and educational interventions that should be provided to all female patients who are diagnosed with HPV infection. Inclusion of these interventions can reduce the emotional stress that occurs with the diagnosis and can augment a patient's coping skills, thereby serving to improve adherence to the treatment plan and promote a greater sense of empowerment and wellness for the patient.

From quarantine to condoms: shifting policies and problems of HIV control in Cuba.

This study reviews HIV prevention in Cuba in light of (1) the liberalization of HIV quarantine, (2) the growth in tourism, and (3) the aggressive system of public health promotion. Sixty-two key informants, including Cubans who are HIV-positive, at risk, or working as health professionals, were interviewed during June and July of 1996. Findings include: (1) there is a common public perception that the government's national HIV screening and contact tracing system obviates the need for individual precaution; and (2) both commercial sex workers and men who have sex with men believe that legal and social forces hinder their indigenous HIV prevention efforts. A well developed system of preventive health care offers the potential for effective HIV prevention. The fact that Cuban officials use the success of their HIV/AIDS control program to promote national pride may retard appropriate changes in their response to currently rising levels of infection.

College health providers' knowledge, attitudes, and management practices of genital HPV infection.

This comparative survey of college health providers explored nurse practitioners' (N = 73) and physicians' (N = 70) knowledge, attitudes, and management practices related to genital human papillomavirus (HPV) infection in females. Both groups had adequate knowledge of basic issues of HPV epidemiology, diagnosis, and treatment. Divergent attitudes and management practices were reported among the providers, with generally low agreement with national STD treatment guidelines published by the Centers for Disease Control and Prevention (CDC). Generally, providers tended to practice a more aggressive management approach on several aspects of HPV infection than recommended by the CDC guidelines. The one major exception reported by the majority of providers was the conservative use of colposcopy for identifying subclinical HPV infection in patients with external genital warts, a finding consistent with CDC guidelines. The availability of colposcopy within a provider's health center was found to be associated with the reported use of colposcopy. Recommendation for future research and implications for college health and advanced nursing practice are addressed.

Malnutrition and disability: unexplored opportunities for collaboration.

There is increasing international interest in the links between malnutrition and disability: both are major global public health problems, both are key human rights concerns, and both are currently prominent within the global health agenda. In this review, interactions between the two fields are explored and it is argued that strengthening links would lead to important mutual benefits and synergies. At numerous points throughout the life-cycle, malnutrition can cause or contribute to an individual's physical, sensory, intellectual or mental health disability. By working more closely together, these problems can be transformed into opportunities: nutrition services and programmes for children and adults can act as entry points to address and, in some cases, avoid or mitigate disability; disability programmes can improve nutrition for the children and adults they serve. For this to happen, however, political commitment and resources are needed, as are better data.

Research note: social catalysts in health promotion implementation.

Recent work carried out by WHO has recognised that an assets based approach to health promotion is crucial to support the promotion of population health and to reduce health inequalities. The assets approach was applied in a project aimed at promoting physical activity among women in difficult life situations. Within the participatory and collaborative work of the project, a specific set of assets for health that might initiate social participation and collaboration in health promotion action emerged. These assets are referred to as social catalysts for health promotion implementation. The article describes empowered individuals, informal social networks, mediating social institutions and organisational structures as potential social catalysts for health promotion implementation, and outlines some directions for further research on this topic.

A cross-cultural program for environmental management.

For those who have responsibility for safety programs in health facilities the primary objective is to effectively orient, train and retrain environmental service and housekeeping personnel, regardless of their individual background, so that each employee has the knowledge, skills and work habits to safely and effectively meet performance expectations. With an increasingly diverse multicultural workforce, however, we need to reexamine many of our assumptions of what constitutes adequate safety training for all employees. This paper examines some of the basic issues that arise when addressing a multicultural workforce. Two questions are at the heart of the discussion: (1) how do you effectively communicate with a multicultural base group, and (2) how do you know if your communication has been effective to ensure the health and safety of your employees?

Psychosocial and educational services for female college students with genital human papillomavirus infection.

CONTEXT: College-age women have a high risk of acquiring human papillomavirus (HPV) infection, which may have substantial psychosocial and physical effects. Young women who become infected need information and support from health care professionals, but little is known about providers' attitudes toward or provision of interventions for helping women cope with HPV. METHODS: A survey of 73 nurse practitioners and 70 physicians in college-based health clinics explored their perceptions of the need for psychosocial and educational interventions and their practices regarding such services for HPV patients. Analysis of variance and chi-square testing were used to examine differences by providers' type and gender. RESULTS: At least 86% of providers agree that HPV infection has a variety of psychosocial effects on young women, but only 54% spend at least 10 minutes providing education and counseling to all of their HPV patients. Roughly 80-90% routinely take a sexual history, explain the potential of HPV recurrence and discuss the risk of cancer with HPV patients; however, fewer than half always offer a variety of other interventions that could help patients cope with the diagnosis and promote preventive behaviors. Female providers are more aware of the psychosocial impact of HPV and the need for support than are male providers. However, nurse practitioners provide counseling and educational interventions more frequently than do physicians, even when gender is controlled for. CONCLUSIONS: College-based health providers need to improve the content of the counseling and education they offer to women with HPV, as well as the consistency with which they deliver those interventions. When they are unable to provide services, they should be able to refer patients elsewhere.

Characterization of the mouse epidermal growth factor promoter and 5'-flanking region. Role for an atypical TATA sequence.

As a step toward delineating mechanisms that regulate its activity, we have characterized the mouse epidermal growth factor (EGF) promoter. Primer extension and S1 nuclease analyses identified prominent (+1/+2) and minor (+28) transcription start sites, with the dominant +1/+2 site located 33 bases downstream from a TTTAAA sequence. A restriction fragment that spanned these start sites and contained 390 base pairs of 5'-flanking sequence directed transcription from the +1/+2 site in vitro in the presence of HeLa cell nuclear extracts. Additionally, it promoted expression of a coupled luciferase reporter gene in transfected cell lines. The inclusion of additional 5'-flanking sequence either stimulated or inhibited luciferase expression depending on the cell line. Approximately 2 kilobases of EGF 5'-flanking sequence was determined and found to contain several motifs with partial homology to steroid hormone response elements. Despite this fact and evidence that EGF expression might be regulated by androgens in vivo, EGF promoter-luciferase constructs were not steroid-responsive in cells cotransfected with steroid receptor expression vectors. An oligonucleotide containing the aforementioned TTTAAA sequence specifically bound TATA-binding protein and TFIIA in gel shift assays, and an EGF promoter-luciferase construct in which the core TA dinucleotide was mutated to CG was not active in transfected cells. These data suggest that the TTTAAA sequence functions as an atypical TATA box.

Epidemiology of firearm mortality and injury estimates: state of Connecticut, 1988-1993.

STUDY OBJECTIVES: To retrospectively determine the 6-year cumulative incidence rate of firearm mortality and estimate nonfatal firearm injuries in Connecticut. METHODS: Retrospective analysis of data originating from the Connecticut State Medical Examiner's Office and records from the Trauma Registry of one urban hospital. RESULTS: From January 1988 through December 1993, 1,625 Connecticut residents died from firearm-related injuries. The cumulative incidence rate was 49.4 deaths per 100,000 population during the 6-year study period. Rates peaked among 20- to 24-year-olds at 18.1 deaths per 100,000. Males outnumbered females more than eightfold. The ratio of nonfatal firearm injuries to firearm deaths was 7:1 for those shot by another, self-inflicted injuries were fatal in half of all cases. CONCLUSION: Analysis of firearm mortality data indicated that males in younger age categories were disproportionately affected. These rates combined with nonfatal injury projections demonstrate that firearms represent a significant public health threat to the population of Connecticut, reaching epidemic proportions among specific subpopulations. These results are consistent with those obtained from national studies.