Women's health (Hillsdale, N.J.)最新文献

Health care costs in the United States now consume nearly 15% of the gross domestic product. Continued expansion of health expenditures may have serious economic consequences, including reduction in the standard of living. Health care reform must include cost control without consequent detrimental effects on health status. As a case example, we consider the controversy surrounding mammography screening for premenopausal women. Several literature reviews of published studies suggest that screening of women less than 50 years of age does not statistically significantly reduce mortality from breast cancer. These results are not explained by screening interval, recentness of study, or patient compliance to screening. We conclude that screening is effective in decreasing mortality from breast cancer for women older than 50 years. For women less than 50, mammography screening programs displace resources that could have a greater benefit in women's health status if used for other purposes.

Navarro and Kaplan's article on the cost-effectiveness of mammography screening for women under 50 offers a limited perspective on a complex and rapidly evolving issue. They suggest that eliminating mammography benefits for younger women will result in the delivery of other important women's health services, but they provide no data on the cost-effectiveness of these programs compared to mammography. Four other areas of omission significantly limit this article's scope and potential impact. Navarro and Kaplan do not discuss: 1) increasing breast cancer incidence in women under 50, particularly in African-American women; 2) the importance of breast cancer risk in relation to mammography screening; 3) the relevance of meta-analyses of randomized clinical trials done by other investigators; and 4) the heterogeneity of mammography screening recommendations in clinical practice.

The debate concerning the effectiveness of mammography screening for reducing breast cancer mortality rates among women in their 40s is explored. The most recent data from randomized clinical trials (RCTs) are presented. Lack of adequate statistical power in these trials is addressed. Temporal factors in young women's breast cancer (sojourn and survival times) that potentially affect RCT outcomes are explored. Current and planned activities at the national and international levels aimed to further examine the highly controversial issue of mass screening of younger women are described.

The relation among need for certainty, type of information presented about a genetic test, and level of interest in predictive genetic testing was examined. Participants were randomly assigned to receive 1 of 2 descriptions of the test. The only difference between the descriptions was that one included a paragraph that emphasized the cancer risk remaining for those who test negative for gene mutations. As predicted, a significant interaction between need for certainty and type of information presented was observed. Whereas women high in need for certainty were more interested in genetic testing when provided with the standard description and less interested when provided with the more complete one, women low in need for certainty showed the opposite pattern. The results suggest that interest in genetic testing is determined by the correspondence between an individual's personal goals and her perception of the kind of information provided by the test.

An observational study of 648 routine medical visits with 69 physicians examined patient gender in relation to patient and physician communication, patient preference for the physician's communication style, patient satisfaction, and the physician's awareness of the patient's satisfaction. Data consisted of audiotapes as well as patient and physician questionnaires. Women appeared to be more actively engaged in the talk of medical visits--they sent and received more emotionally charged talk and were judged by independent raters as more anxious and interested both globally and in terms of voice quality than men. Consistent with the more emotional talk, women reported preferring a more "feeling-oriented" physician than male patients did. Mean levels of satisfaction with communication did not differ by gender, and communication predictors of satisfaction were similar for male and female patients, although they were stronger for male patients. Physicians were significantly less aware of some aspects of female patients' satisfaction compared to male patients' satisfaction. In light of the weaker correlations between patients' communication and their satisfaction for women, we suggest that women provided fewer obvious cues to their satisfaction. Training in communication skills may increase open discussion about feelings and emotions and may also produce greater physician sensitivity to patients' satisfaction, particularly with female patients.

Although a remarkable degree of consensus has been reached among international agencies, policymakers, and women's health advocates that the practice of female circumcision should be eliminated, such consensus is not necessarily shared by those who perform the operation or the families responsible for having girls excised. The surgical procedure is nested in a complex set of beliefs about identity, moral behavior, and the working of the female body. This article describes the dominant themes produced in 85 extensive interviews with mother and operators representing the broad spectrum of Egyptian society. The interviews detailed the operation itself, women's emotional response to the operation, and the rationales put forth in support of the practice. Although institutional efforts to eliminate the practice will meet with resistance, significant demographic shifts already taking place are producing changes in family systems and the opportunity structure that coincide with the abandonment of excision in key sectors of the urban population.

The growing interest in women and health is resulting in an expanding number of important issues and invested disciplines. In this article, we propose a framework to serve as a guide for organizing themes and integrating competing approaches to the field of women's health. Our framework is illustrated through a multilevel circular model that graphically represents the evolving nature of the field. We first describe key content areas in women's health, including topics that have traditionally been considered, as well as those that have only more recently received attention. We then discuss research processes and methods that are important in the field and call for the use of approaches often excluded from traditional scientific procedures. Finally, we address the conceptual models that various disciplines provide and the advantage of a multidisciplinary perspective to advancing the field of women's health.

Measuring only the physical markers of violence (e.g., slapping, beating) fails to capture the chronic vulnerability and gendered nature of battered women's experiences. Instruments that measure only observable discrete events may mask the continuous nature of battering and the relation between events and experience. Our approach to measuring battering operationalizes the experiences of battered women rather than the abusive behaviors they encounter. This alternative approach emphasizes the meanings battered women attach to the violence and to battering as an enduring presence in their lives. Focus groups with 22 battered women generated qualitative data for developing scale items (Smith, Tessaro, & Earp, 1995) and a known-groups survey with 185 battered and 204 nonbattered women determined the final scale items. Factor analysis of 40 initial items revealed a strong single-factor solution. The resulting 10-item Women's Experiences with Battering (WEB) Scale demonstrated high internal consistency reliability, was significantly correlated with known-group status, exhibited good construct validity, and was not significantly correlated with a measure of social desirability. The WEB Scale provides researchers with a valid and concise measure for studying relations between battering and health or health behavior, as well as evaluating the impact of interventions on battered women or prevalence.