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ABSTRACT: to determine Chilean midwives' views with regard to Chilean women's health-care needs in midlife. The aim was also to explore Chilean midwifery students' views on the clinical care provided to women in midlife.
a qualitative study using focus group discussions and narratives which were analysed using thematic manifest and latent content analysis.
10 different primary health care (PHC) centres in Santiago, Chile.
22 midwives, working in PHC clinics and 13 (n = 13) midwifery students with PHC clinical experience, attending their fourth or fifth year of midwifery education at the School of Midwifery in Santiago.
the midwives felt that women in midlife have special health-care service needs. They also considered themselves to be the most appropriate health staff to provide health care for women in midlife, but recognised that they lacked competence in attending psychological and social health-care needs of women in midlife such as violence, abuse and sexuality issues. The midwifery students remarked that many midwives focused their attention on fulfilling the biomedical requirements. Even if the midwives had knowledge about recent research on menopause, they had difficulties in approaching this issue and including it in their counselling. Some students also questioned the sometimes disrespectful attitude shown, especially towards Peruvian immigrants and women with psychosocial problems.
the findings suggest that midwives need more education about women's health-care needs in midlife, and that more focus should be placed on the psychosocial aspects of midwifery. More reflections about the quality of the client-provider relationship in clinical practice are needed. Gender issues, the structure of power relationships, and empowerment should be incorporated and critically discussed during midwifery education and training, and also in clinics.
Midwifery 08/2011; 27(4):417-23. · 1.78 Impact Factor
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ABSTRACT: This study explored how Chilean immigrant women living in Sweden perceived and related their life situations and health status during midlife to their migration experiences.
Three focus group discussions (FGDs) were performed with 21 middle-aged Chilean women (40-60 years) who had lived in Stockholm for at least 15-20 years. In-depth interviews were held with three key informants. A combination of manifest and latent content analysis was performed to structure and categorize the tape-recorded and transcribed data.
Three main themes emerged from the data: (i) Chilean women's reflections about migration and resettlement; (ii) Health during midlife; perceptions of Chilean women living in Sweden; and (iii) Strategies to manage their lives and to gain social acceptance and position. The Chilean women reflected about the discrimination they had met in the Swedish society and within the health care system along with health changes they had had during midlife. They connected some of their health related problems to their hardships of migration. They also expressed confusion about the health care they had received in Sweden including conflicting and mistrusting relationship with some health care providers. Important for their way of coping with their own health seemed to be a recognition of their own space, level of independence, self-acceptance and awareness of power relationships.
The results illuminate the importance of awareness of influence of gender and socio-cultural aspects, power relationships and communication skills among health care providers on women's health. Complementary interventions to the biomedical paradigm are needed and should be addressed in Swedish health staff educational programmes as well as in clinical training.
Scandinavian Journal of Caring Sciences 09/2010; 24(3):445-53. · 0.89 Impact Factor
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ABSTRACT: In order to learn about Chilean women's reflections about womanhood and sexuality during midlife, we held focus group discussions (FGDs) with middle-aged Chilean women living in Stockholm, Sweden, or in Santiago, Chile. We used thematic content analysis for the qualitative data. Emerging themes follow; societal expectations on women, perceptions about sexual relationships, and women's social stigmatization. The women had since childhood been strongly influenced by a gender-imbalanced world, which had made them socially, economically, and biologically at higher risk for exploitation during life. More focus should be directed to middle-aged women's life situation and promotion of gender equity in society.
Health Care For Women International 12/2009; 30(12):1093-110. · 0.63 Impact Factor
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ABSTRACT: Background: Inadequate lifestyles (LS) in young women may be related to the increasing population that migrate to the cities. Objective: To compare the LS in rural and urban women and to assess their relation with educational levels and cardiovascular risk factors. Material and methods: Four hundred and eleven women (233 from rural and 178 from urban areas) aged 20 - 44 years were studied using the McMaster University questionnaire 'Do you have to fantastic lifestyle?'. Results : The mean age was similar in both groups (30.9 ± 7.2 years for rural vs 29.6 ± 7.3 for urban). Of the interviewed subjects, the rural women had a lower education level (47.2% had more than 8 years of study vs 73.6%; p<0.0001) and had a partner more frequently (68.3% vs 53.4%; p<0.04). The LS were better in the rural area (70.4 ± 12.4 vs 66.7 ± 14.0, p<0.01) and this was determined by less consumption of alcohol and drugs, more physical activity and higher family support. A higher level of schooling was related to better LS. Additionally, the women who had good LS had a lower body mass index. Conclusion: The urban women have worse LS than the rural ones. In both groups, the educational level was associated with healthier LS and less obesity, well-known risk factors for chronic diseases.
Vascular Disease Prevention 04/2006; 3(2):79-82.
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ABSTRACT: It has been suggested that psycho-social factors may be crucial in the development of climacteric symptoms.
In order to evaluate the effect of psycho-social and biological factors on menopausal symptoms, Greene (climacterical symptoms), Cooper (psychosomatic symptoms of stress), Smilkstein (family dysfunction), Duke-UNC (social support) and Israel (life events) tests were passed to 300 Chilean women between 40 and 59 years of age. Data were evaluated with ANOVA, chi2 and logistic regression using the Epi-info package.
Perimenopausal women had a significant increase in stress and climacteric symptoms; however comparing with pre and postmenopausal women, tests for life events, family dysfunction or social support did not show any differences. A history of premenstrual syndrome was the main risk predictor f or climacteric symptoms (OR: 3.6, IC: 1.5-8.5; P < 0.03 ), followed by perimenopausal state (OR: 2.9, IC: 1.4-6.0; P < 0.001 ) and negative life events (OR: 2.3, IC: 1.0-5.3; P < 0.05 ). The psycho-social factors were predictors for anxiety and depression; on the other hand, perimenopausal state was a risk factor for somatic and vasomotor symptoms. During premenopause, women with regular cycles and vasomotor symptoms have more psychological symptoms and stress.
Climacteric symptoms that appear in the perimenopause are more intense in those women who have a biological predisposition such as premenstrual syndrome and are modulated by psycho-social factors.
Maturitas 08/2004; 48(4):425-31. · 2.77 Impact Factor
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ABSTRACT: To assess the effect of the publication of the Women's Health Initiative (WHI) study on patients' and physicians' attitudes in relation to hormone therapy (HT).
A survey focused on the degree of knowledge and on the reactions to the WHI study was administered to 600 women allocated in two groups according to their socioeconomic status, high (HSES) or low (LSES). Additionally, 283 physicians were surveyed to determine their attitudes regarding HT after the publication of the WHI study. The rates of HT prescription before and after publication of the study were compared.
Among patients, HT use and knowledge of the WHI study were less common among women of lower socioeconomic status (LSES 16.7% v HSES 47.3%, and LSES 15.7% v HSES 67.3%; P < 0.0001). Of the women in the LSES group who were HT users and had knowledge on the subject of the WHI study (n = 30), 56.7% contacted their physicians and 6.6% abandoned HT. These rates were similar for women in the HSES group. Among physicians, 97.2% of physicians referred to being aware of the WHI study, and 64.7% modified their clinical approach. The main changes were that 21.5% applied more rigorous risk/benefit assessment, 20.1% lowered hormone dosage, 18.8% decreased continuous-combined therapy use, 12.1% shortened the duration of HT, 7.7% abandoned medroxyprogesterone or conjugated estrogen use, and 5.0% increased the use of transdermal estrogens, tibolone, or other alternatives. As for prescriptions, after the publication of the WHI study, there was an 8.6% drop in the rate of HT prescriptions. This decrease was more pronounced for prescriptions based on conjugated equine estrogen and medroxyprogesterone acetate. In contrast, prescription of transdermal estrogens and tibolone increased 5.2% and 16%, respectively.
There was a significant change in physicians' and patients' attitudes toward HT after publication of the WHI study.
Menopause 12/2003; 11(1):57-61. · 3.76 Impact Factor
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ABSTRACT: It is generally accepted that menopause significantly modifies cardiovascular risk. The effects of hormone replacement therapy (HRT) on this risk remain controversial.
To study the prevalence of cardiovascular risk factors (RF) in middle-aged women and their changes with aging, menopause and hormone replacement therapy (HRT).
Cardiovascular risk factors were assessed in 576 women aged 40 to 59 years in 1991-92. Five years later, 467 of these women were reassessed.
Sedentarism (87.2%), dyslipidemias (71.5%), high blood pressure (13.5%), obesity (13.1%), smoking (12.4%) and diabetes (2.8%) were the most prevalent RF. Five years later, the prevalence of hypertension increased to 20.9%, the prevalence of obesity increased to 27.3%, smoking increased to 20.8% and diabetes to 5.9%. The prevalence of dyslipidemia did not change, although triglycerides levels rose from 125.9 +/- 56.4 to 136.8 +/- 63.5 mg/dl (p < 0.001). Sedentarism dropped to 58.8%. Menopause did not deteriorate any of these RF. The use of HRT increased during the 5 years follow-up from 3.8% to 35%. Women on HRT experienced 3% decrease in LDL-cholesterol and 9% increase in HDL-cholesterol levels.
Middle aged women included in this cohort have a high prevalence of RF. There is a deterioration with age, but not with menopause. HRT improves the lipid profile.
Revista medica de Chile 04/2003; 131(4):381-9. · 0.33 Impact Factor
