Coping with infertility: distress and changes in sperm quality.
(25/3097)
Infertility represents a serious stressor for some patients as well as a risk factor for a decrease in sperm quality. The purpose of the present study was to identify coping strategies that went along with both better emotional and physical adjustment to infertility. The sample consisted of 63 patients who contacted an andrological clinic more than one time. Prior to clinical examination, patients filled out a questionnaire referring to the way in which they coped with their wives' previous menstruation. Participants also completed a scale assessing perceived distress due to infertility. Change in sperm concentration since baseline semen analysis and the level of distress were used to evaluate patient's adjustment. The better-adjusted patients showed less prominent overall coping efforts, and a higher proportion of distancing coping strategies. An improvement in sperm quality also was associated with a low cognitive involvement in infertility. Situational uncontrollability of infertility could be a moderator of the effectiveness of coping employed by the better-adjusted patients. In addition, the coping behaviour related to better adjustment could be due to a dispositional stress resistance factor. For clinical implementation of the findings, the attitudes of a patient and the expectations of his wife have to be taken into consideration. (+info)
Sexual health risk assessment and counseling in primary care: how involved are general practitioners and obstetrician-gynecologists?
(26/3097)
OBJECTIVES: This study examined physicians' evaluation of sexual health risks during a general medical examination and sexually transmitted disease (STD) counseling during consultations for adolescent contraception and treatment of an STD. METHODS: An anonymous mail survey was conducted in 1995 with a stratified random sample of 1086 general practitioners and all 241 obstetrician-gynecologists practicing in Quebec, Canada. RESULTS: Fewer than half of the respondents reported routinely inquiring about condom use and number of sexual partners during a general medical examination. Female general practitioners engaged in more sexual health risk assessment and counseling than male general practitioners. CONCLUSIONS: This study suggests a low level of involvement in STD prevention by generalists and obstetrician-gynecologists. (+info)
A randomized trial of breast cancer risk counseling: the impact on self-reported mammography use.
(27/3097)
OBJECTIVES: We evaluated the impact of individualized breast cancer risk counseling on mammography use among women at risk for breast cancer. METHODS: Participants (n = 508) were randomized to the breast cancer risk counseling intervention or a general health education control intervention, and 85% completed follow-up. RESULTS: In multivariate modeling, a significant group-by-education interaction demonstrated that among less-educated participants, breast cancer risk counseling led to reduced mammography use. There was no intervention effect among the more-educated participants. CONCLUSIONS: These results suggest that standard breast cancer risk counseling could have an adverse impact on the health behaviors of less-educated women. (+info)
Patients' reports of counseling on mammography screening by health-care providers--North Carolina, 1997.
(28/3097)
Regular mammography screening combined with timely and appropriate treatment can reduce mortality from breast cancer by 30% in women aged 50-69 years and 16% in women aged 40-49 years. A physician's recommendation has been strongly associated with a patient having a mammogram. This report analyzes data collected during 1997 in North Carolina as part of the Behavioral Risk Factor Surveillance System (BRFSS), which indicated that 23% of women aged > or =40 years who had had a routine physical examination during the 2 years preceding the survey did not recall having a discussion about mammography with a health-care provider. (+info)
Prenatal discussion of HIV testing and maternal HIV testing--14 states, 1996-1997.
(29/3097)
In July 1995, the Public Health Service recommended that health-care providers counsel all pregnant women about human immunodeficiency virus (HIV) prevention and encourage testing for HIV infection and, if indicated, initiate zidovudine therapy. To evaluate compliance with these recommendations, CDC analyzed population-based data on HIV counseling and testing during 1996-1997 from 14 states participating in the Pregnancy Risk Assessment Monitoring System (PRAMS). This report presents an analysis of survey data collected from 1996 through 1997; results indicate that HIV counseling and testing of pregnant women were common but varied by state, type of prenatal health-care provider, Medicaid status, and maternal demographic characteristics. (+info)
Is telephone counselling a useful addition to physician advice and nicotine replacement therapy in helping patients to stop smoking? A randomized controlled trial.
(30/3097)
BACKGROUND: The authors evaluated the incremental efficacy of telephone counselling by a nurse in addition to physician advice and nicotine replacement therapy in helping patients to stop smoking. METHODS: The trial was conducted at the University of Ottawa Heart Institute. A total of 396 volunteers who smoked 15 or more cigarettes daily were randomly assigned to either of 2 groups: usual care (control group) and usual care plus telephone counselling (intervention group); the groups were stratified by sex and degree of nicotine dependence. Usual care involved the receipt of physician advice on 3 occasions, self-help materials and 12 weeks of nicotine replacement therapy. Telephone counselling was provided by a nurse at 2, 6 and 13 weeks after the target quit date. Point-prevalent quit rates were determined at 52 weeks after the target quit date. RESULTS: The point-prevalent quit rates at 52 weeks did not differ significantly between the control and intervention groups (24.1% v. 23.4% respectively). The quit rates did not differ significantly at the secondary measurement points of 4, 12 and 26 weeks. INTERPRETATION: Brief physician assistance, along with nicotine replacement therapy, can help well-motivated smokers to quit. Three additional sessions of telephone counselling by a nurse were ineffective in increasing quit rates. This form of assistance may be useful in the absence of physician advice or when self-selected by patients. (+info)
Psychosocial and educational services for female college students with genital human papillomavirus infection.
(31/3097)
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. (+info)
Psychotherapeutic counseling and pregnancy rates in in vitro fertilization.
(32/3097)
PURPOSE: Since the Austrian propagation bill of July 1, 1992, was passed into law, Austrian physicians are committed to offer psychological counseling to women before performing assisted reproductive techniques, unless refused by the patient. The acceptance of psychotherapeutic counseling (PSITCO) and its influence on pregnancy rate were carefully reviewed. METHODS: The study comprised 1156 consecutive patients (mean age, 33.3 years) and 1736 in vitro fertilization (IVF) cycles. In a consent form for follicle puncture, the patients were interviewed about PSITCO as follows. Several methods of psychological support during IVF-embryo transfer treatment were offered to patients especially psychotherapy, hypnotherapy, and relaxation and physical perception exercises. RESULTS: Forty-two and three-tenths percent of patients rejected PSITCO, 17.8% had already received PSITCO, and 10.4% were willing to undergo PSITCO. The acceptance of PSITCO had no relevance on pregnancy rate. The cumulative calculation of pregnancy rates showed that up to 56.4% of women who had undergone PSITCO conceived. In patients who were planning to undergo PSITCO, the pregnancy rate was 41.9%. Concerning the cumulative pregnancy rate, this study showed that patients who accepted or underwent PSITCO had a higher pregnancy rate than those who did not avail themselves of this possibility. CONCLUSIONS: These results should encourage sterility specialists to consider psychological therapy as an essential aspect of IVF. Solely a written declaration of the patient stating his/her awareness of the possibility to undergo PSITCO is, in our opinion, insufficient. (+info)